Terms and conditions of this practice

1) The Practice and this agreement

a) “The Practice” means Dr PJ Malherbe Inc.; its staff include authorised reception, administration and billing personnel. Zwavelstream Clinic and independent healthcare providers are separate providers with separate accounts.

b) The Costing guide and First Consult and Follow-up Consult billing procedures, available online and from reception, form part of this agreement. The separate Medical scheme benefits and hospital admission acknowledgement also apply to admissions.

c) These terms govern financial and administrative responsibilities; the costing guide specifies tariffs and option exclusions, and the procedures explain payment routes. All are subject to law and binding provider agreements. No non-excludable duty or liability is excluded.

2) Fees and scheme contracts

a) Fees depend on the service, duration, code and applicable private tariff or binding scheme agreement. The charging basis is disclosed before non-emergency services; final fees reflect work required and performed. Listed scheme tariffs do not guarantee benefits or reimbursement.

b) The Practice may enter into, amend or terminate scheme contracts. Check current contracting and payment arrangements with reception before each consultation or admission; previous acceptance does not guarantee continued acceptance. Reception cannot confirm benefits.

c) Individual notification of contract changes is not required unless law or a binding agreement requires it. Changes are prospective: agreed charges for completed services remain unchanged. Revised tariffs and payment requirements are available before further non-emergency services.

3) Charges and payment routes

a) First consultations are billed using both codes 0162 and 2974 where services and documented time support both. Follow-ups use 0162, 2957, 2974 or a scheme-specific alternative. Codes reflect actual services, duration and coding requirements, not funding eligibility alone. The published procedures explain scheme alternatives, including Bestmed’s 7026 arrangement.

b) Where the First Consult procedure provides, you pay the 0162 part at consultation and claim it back from your scheme, and the Practice submits the 2974 part to your scheme when its conditions are met. If direct claiming is unavailable, you pay and claim reimbursement yourself. Payments are reconciled; the published private fee is the account cap.

c) The costing guide specifies outpatient co-payments, including Bestmed, Sasolmed and conditional co-payments for other schemes. PMB approval does not guarantee full cover for every service. Charges remain subject to law and binding agreements; statutory PMB rights are preserved.

d) Clinical and administrative work requested outside a booked consultation is a separate service, charged at the fee listed in the costing guide or agreed before work begins. This may include repeat or replacement prescriptions (including those reported lost by a patient or pharmacy), chronic-medication or PMB forms, renewals, motivations, medical-scheme correspondence, reports, certificates, and incapacity, disability or employment applications or updates. A request does not guarantee completion without a consultation or approval of an application. Patients remain responsible for lawful fees, regardless of scheme reimbursement. The Practice will not charge for correcting its own errors.

e) Fees exclude hospital, anaesthetic, pharmacy, pathology, psychology, occupational therapy and other independent provider charges; obtain their terms directly. ECT and other specific interventions require their own clinical consent and fee information.

f) Accounts must show full services, charges, patient and scheme payments, and the balance. Separate payment routes do not permit concealed charges or double recovery.

4)  Scheme responsibilities and PMB applications

a) The agreement for the Practice’s services is between the Practice and the patient or other identified responsible payer. The patient or authorised representative is responsible for obtaining and tracking scheme requirements, forms, referrals, authorisations, deadlines, renewals, requests for further information, decisions, benefit limits, and appeals, including those relating to PMBs and chronic medication. The patient must monitor communications from the scheme or administrator, promptly provide the Practice with any request requiring clinical input, and confirm that the scheme has received and processed submissions.

b) Receipt by the Practice of a copy of scheme correspondence does not mean that the Practice has undertaken to monitor the application, respond to every scheme request or follow up its outcome. If the Practice expressly agrees to submit a document or perform a specified task, it remains responsible for carrying out that agreed task with reasonable care. Clinical assessment and appropriate information supplied by the psychiatrist remain subject to professional duties.

c) The Practice cannot check every scheme or option requirement or predict payment. Published billing guidance may change due to factors beyond its control; you remain responsible for current benefit enquiries.

d) Raise PMB applications and chronic applications with the psychiatrist and complete them during consultation where clinically indicated. Bring the current form, completed member’s section and required scheme information. Reception does not assess PMB or chronic eligibility.

e) Applications, renewals and motivations requested outside consultation require a separate arrangement and may require another consultation and disclosed lawful fees. Completion depends on adequate clinical information and available clinical time; we do not guarantee immediate responses.

f) The psychiatrist may supply appropriate clinical information. Diagnoses and reported services follow the clinical record and will not be altered merely to obtain payment. Follow up adverse decisions with your scheme. Administrative requirements do not extinguish statutory PMB entitlement.

5)  Hospital admission and inpatient charges

a) Before and throughout admission, you or your authorised representative must confirm authorisation, effective dates, funded days, review/expiry dates, extensions and separate professional cover, including the effect of previous admissions, outpatient claims and other benefit use. After emergency admission, do so as soon as reasonably possible.

b) The Practice and reception do not obtain admission authorisations, verify hospital benefits, monitor authorised days, arrange administrative extensions or provide hospital case management. Enquire directly with your scheme. Hospital assistance or the psychiatrist’s clinical information, treatment plan or motivation does not transfer your administrative responsibilities to the Practice.

c) Promptly notify the hospital and Practice of funding refusal, exhaustion, expiry, review or change. Clinical recommendations for admission or continued care do not guarantee payment. Discharge remains a clinical decision informed by the treating team.

d) Inpatient claims use the applicable scheme tariff where available, without predicting payment. The Practice adds no patient co-payment to scheme-funded inpatient consultations and accepts payment under applicable scheme arrangements. Private-paying patients and unfunded services attract the disclosed private tariff, subject to law, binding agreements and the private-rate cap. Prior payments are credited.

6) Payment and claims

a) Adult patients are personally liable for lawful fees, including co-payments and unfunded services, even as scheme dependants. Scheme payments and credits reduce liability. For minors or represented patients, identify the responsible payer and signatory’s authority; treatment consent and financial responsibility are separate.

b) Claim submission is administrative assistance, not a guarantee of scheme receipt, acceptance or payment. The Practice remains responsible for billing it undertakes and correcting identified errors. Supply accurate information and answer scheme queries directed to you.

c) Private accounts and amounts designated payable at consultation are due then. Other balances are due within 30 calendar days of the account date unless otherwise lawfully agreed in writing. Instalments or extended credit are not automatic entitlements.

d) Pending claims, reimbursement disputes or PMB applications do not themselves suspend lawful payment obligations. Rejection does not make an unlawful charge payable. Reversed payments may reinstate lawful debt; later receipts are reconciled to avoid double recovery.

7) Arrears and recovery

a) Keep contact, membership and billing details current and review accounts promptly. Disputes must identify the invoice date, service and reason; undisputed amounts remain payable. Inform the practice if you have not received an expected account 30 days after service; non-receipt does not extinguish the debt.

b) After reasonable collection attempts and applicable notices and procedures, arrears may be referred to the billing bureau, a registered debt collector or attorneys. Recoverable collection costs and credit reporting are subject to law; reporting is not automatic.

c) Interest is reserved only where legally and professionally permissible, without an automatic monthly charge. Any contractual rate and charging basis must be separately disclosed, accepted and compliant with law and HPCSA requirements.

d) Concessions, discounts or delayed enforcement create no continuing entitlement or waiver. Payment arrangements require written confirmation by an authorised Practice representative; the Practice need not grant credit or accept proposed instalments.

e) Subject to the psychiatrist’s clinical assessment, the Practice may decline or defer further appointments or services until lawful arrears are settled or an accepted arrangement is met. The Practice will inform existing patients before restrictions affect ongoing care. Section 10 governs termination.

f) The Practice will not withhold treatment outcomes, investigation results, or safe-handover information to enforce payment. Lawful fees remain payable for necessary transitional services.

8) Appointments and cancellation

a) Give 48 hours’ notice to cancel or reschedule, where possible. A charge may apply for less than 24 hours’ notice or non-attendance. Use designated telephone or email channels; email receipt determines notice. Retain evidence.

b) Where the policy was disclosed at booking and charging requirements are met, a reasonable cancellation/no-show fee up to the booked consultation’s private fee may apply. The Practice will establish the reason and record unsuccessful reasonable efforts to refill the slot. Charges reflect notice, booking, replacement prospects and legal/professional requirements.

c) No charge applies if you cannot attend due to death or hospitalisation, or where a charge is otherwise prohibited. Other emergencies are assessed individually; we may request reasonable supporting information. A waiver does not change the future policy.

d) Cancellation/no-show fees are your responsibility, identified separately, and may not be claimed from a scheme as treatment. Reminders are a courtesy: not receiving or failing to read them does not cancel bookings or excuse attendance/cancellation. Arrange replacement appointments yourself.

e) Lateness may shorten consultations or require rescheduling; charges reflect services rendered or lawful cancellation fees. Repeated non-attendance may invoke section 10. Emergencies or clinical overruns may delay appointments; we will communicate material delays/cancellations where practicable. No patient cancellation fee applies if the Practice cannot provide the booked service.

9) Care consent and communication

a) Provide accurate, complete relevant information, including medicines, substance use, allergies and previous treatment. Follow agreed treatment and reasonable practice rules; disclose inability or unwillingness to follow recommendations. Outcomes are not guaranteed. The Practice is not liable for loss caused solely by withheld/inaccurate information, failure to follow agreed care or independent third-party conduct for which it is not legally responsible.

b) You voluntarily consent to psychiatric assessment and care by Dr PJ Malherbe and implementation of a treatment plan discussed and agreed upon, including consultations, clinically indicated examinations/investigations, medication management, psychotherapy and follow-up. Before an investigation or treatment, its nature, purpose, expected benefits, material risks, reasonable alternatives and relevant costs will be explained, with an opportunity for questions and a decision. Agreement and material treatment changes will be recorded. This does not authorise every intervention or replace specific informed consent, including for ECT. You may decline or withdraw future consent, subject to law, without cancelling fees already lawfully incurred. Care/admission without consent follows applicable law, including the Mental Health Care Act 17 of 2002.

c) Use telephone or email, not WhatsApp or social media, to contact the Practice. Routine messages are handled in working hours; immediate responses are not guaranteed. Email is not an emergency communication channel: in an emergency seek the nearest emergency unit or, in hospital, alert nursing staff.

10) Conduct, termination and complaints

a) The Practice may terminate care on reasonable professional grounds: trust breakdown preventing effective care; threats, abuse or harassment; persistent non-payment after notice; withholding material clinical information; repeated non-attendance or non-cooperation making safe care untenable; unlawful/unethical demands; associates’ interference materially compromising safe care; or needs exceeding competence or available services.

b) The psychiatrist decides termination in the clinical circumstances and under legal/HPCSA duties. Written notice will state reasons, termination date and interim/referral arrangements. Reasonable notice considers medication, clinical risk and alternative access. Required continuity steps may include referral, a summary and appropriate medication. Cooperate and arrange subsequent care; the Practice guarantees neither another provider’s availability/acceptance nor indefinite treatment, subject to professional duties.

c) Threats, violence, abuse or harassment may prompt immediate proportionate safety measures: ending consultations, restricting access or specifying communication channels. Emergency duties remain, including appropriate stabilisation/referral within competence and available resources.

d) Termination preserves existing debt and lawful transitional fees. Later settlement does not automatically reinstate care. Notify the Practice when transferring psychiatrists or discontinuing care to clarify follow-up responsibility.

e) Use the complaints procedure available from reception. External complaints, including to the HPCSA, the Council for Medical Schemes, or the Information Regulator, remain available. Complaints do not suspend lawful payment obligations; a complaint or second opinion alone is not grounds for termination.

11) Confidentiality and records

a) The Practice protects information processed for care, records, appointments, billing, lawful recovery and administration. Staff, shared reception, the billing bureau and providers have access only for authorised purposes under confidentiality obligations. Cliniko, Google Workspace, relevant providers and, with section 13 consent, Heidi may process data outside South Africa subject to POPIA safeguards. The privacy notice and information-access manual are available from reception.

b) Disclosure requires consent or another lawful basis, including legally required or permitted care-related disclosure, and is limited to relevant information. Claims/ICD-10 codes may reveal diagnoses to principal members through scheme administration. The Practice is not liable for independent scheme disclosures for which it has no legal responsibility.

c) Request record access, correction or consent withdrawal from the Practice. Withdrawal affects future consent-based processing, not prior lawful processing, mandatory retention or processing on another lawful basis.

d) Section 14 covers only selected information, purposes and identified recipients; relationship categories must identify actual persons/entities. Capacity and representative authority must meet legal requirements; age alone is insufficient. Information-sharing permission does not appoint a substitute treatment decision-maker or permit unlawful disclosure or exclusion of non-excludable liability.

12) Medical scheme disclosure

a) With your authorisation, the Practice and billing bureau may disclose identifiers, membership details, service dates, codes, fees, relevant ICD-10 diagnoses and necessary supporting information for claims/PMB applications. This does not authorise unrestricted record access. Principal members may receive information through scheme administration. If you withhold consent, you are responsible for private fees.

13) Heidi Clinical Scribe consent

a) With consent, Heidi captures/processes consultation audio and relevant clinical information into transcripts and draft notes. The psychiatrist reviews/corrects output and retains clinical responsibility. Heidi states its standard live service retains no playable audio and Scribe patient data is not used for AI training. Transcripts/drafts may remain under configured settings; approved notes form part of the clinical record.

b) Heidi and contracted providers process data electronically, including abroad, subject to POPIA safeguards. Privacy/security risks and output errors remain; no absolute security/accuracy guarantee is given. Consent covers clinical scribing only, not unrelated recordings or AI services. You may decline, stop or withdraw future use; care will be documented otherwise and required records retained. Inform other consultation participants and obtain applicable consent before capture.

14) Consent to disclose information

You may authorise only the disclosures, recipients, purposes and limits of disclosed information, understanding their implications. You must select the intended permissions; section 11 governs lawful disclosure and representative authority. You may wish to:

☐Share health and wellbeing information with my next of kin.

☐Allow another person (e.g. parent/spouse) to attend a consultation/procedure and receive otherwise confidential information.

☐ Give another person (e.g. family) condition updates before, during or after a procedure or admission.

☐ Give another person/entity specified records, including clinical records, reports, sick certificates or prescriptions.

☐ Give information to a person lawfully able to consent to care when I cannot, enabling that decision.

☐Inform my employer of specified matters, including my illness and the duration/reason for absence. I take sole responsibility for consequences of this employer disclosure.

☐Share information with an insurer through forms and/or reports.

☐Supply disability/incapacity reports for temporary/permanent accommodation or medical boarding to my employer or another entity.

☐Share product-related adverse-event information with a pharmaceutical or medical-device company.

☐Share a medico-legal report, second opinion or report to an attorney with another entity.

You may wish to share information with:

☐ Spouse/life partner

☐ Parent(s)

☐ Family

☐ Employer

☐ Legal representative
☐ Insurer 

15) Agreement, financial acceptance and consent to care

You will have read these terms or had them explained in a language you understand, had an opportunity to ask questions, and received or had access to the costing guide and billing procedures. You will have to accept the financial and administrative responsibilities described above, including lawful charges for work outside consultations; obtaining, submitting and monitoring medical-scheme applications, renewals and correspondence except for tasks expressly accepted by the Practice; cancellation charges; and arrears. The Practice does not guarantee reimbursement or provide hospital case management. You must accept these terms and give general care consent in clause 9.2, with specific treatment decisions subject to that informed-consent process. Sections 12–14 apply separately according to your choices and are not automatically authorised by general care consent.