[mono]
MedTak Client Coverage Contract
 ┌────────────────────────┐
 Date and Time: [datetime]
 Signatory Party:      [signature]
 Authorized Personnel: [signature]
 └────────────────────────┘
 MedTak Interstellar guarantees
 emergency response, stabilization,
 and revival to its clients, subject
 but not limited to the exceptions
 listed below¹:
 - Unpaid Fees
 - Hostile actions taken towards
   MedTak personnel
 - Misrepresentation of client
   identity or status
 ┌────────────────────────┐
 Plan² |Bronze|Silver|Gold|:
 [form]
 Surgery Preauthorization:
 [/mono][check][mono]
 └────────────────────────┘

[color=#e6e6e6]
1: Refer to form 18b for full list of
   exceptions and conditions.
2: Coverage and fees vary per plan.

MedTak Interstellar reserves the right to
amend coverage terms.[/color]
[/mono]
