HomeMy WebLinkAboutSchool of EMS Clinical Affiliation Agreement; Jon Alverson, EMS ChiefCzKpoPcfsmboefsbu22; 1:qn-Gfc14-3132
CLINICALAFFILIATIONAGREEMENT
CityofCarmel
And
SchoolofEMS
Thisagreementmadeandenteredintothis (Date) 02/02/2020byandbetweentheCityofCarmel, byandthrough
itsBoardofPublicWorksandSafetyandtheSchoolofEMS, Inc. hereinafterreferredto (SchoolofEMS) and
willcontinueuntiltheagreementisterminatedbyeitherparty.
I. PURPOSE
The ClinicalSiteshallprovidetheSchoolofEMSstudentswithpractical
experienceinEMS-basedpatientcareactivitiesthroughtheClinicalS EmergencyMedicalServicesDivision
andtheSchoolofEMSshallprovidethestudentwithacademicexperience.
II. RESPONSIBILITIES OFTHECLINICAL SITE
TheClinicalSiteshall:
A. ProvidecooperationtoensurestudentsoftheSchoolofEMSreceiveaneffectiveclinicalexperience.
B. Provideasuitableclinicalexperiencesituationasprescribedbythecurriculumprovidedbythe
SchoolofEMSandoutlinedbytheNationalHighwayTrafficSafetyAdministration.
C. AssistwithclinicalteachingandsupervisionofagreeduponnumberofstudentsoftheSchoolof
EMS.
D. EnsurethestandardsofpatientcareestablishedbytheClinicalSiteremainincontrolofthe
employees.
E. ReservetherighttodeterminethemannerinwhichtheClinicalSiteownedequipmentandsupplies
shallbeusedandoperated.
F. ProvideacontactpersonfortheSchoolofEMSattheClinicalSitesoastofacilitateinteraction
betweenthetrainingprogramandoursystem.
III. RESPONSIBILITIES OFTHESCHOOLOFEMS
TheSchoolofEMSshall:
A. EnsurethatstudentswhousetheClinicalS facilitieswillabidebytheClinicalSpolicies.
B. EnsurestudentsoftheSchoolofEMSwillhaveprofessionalliabilityinsuranceintheappropriate
amountpriortobeginningclinicalexperiencewiththeClinicalSite.
C. EnsureeachstudenthasbeenprovidedinfectioncontroltrainingasoutlinedbytheDepartmentof
Transportation knowledgeobjectivesforEMScourses.
D. EnsureeachstudenthasbeenprovidedHIPAAtraininginaccordancewiththeFederalandState
guidelines.
E. Ensureeachstudenthasbeenclearedthroughabackgroundchecktoincludethefederal
inclusion/exclusionlist.
F. Ensureeachstudenthaspasseda10-paneldrugscreen.
G. EnsurethatdocumentationhasbeenestablishedbytheSchoolofEMSonhowstudentsare
determinedtobeproficientinbothbasicandadvancedskillswhichareexpectedtobeutilizedinthe
clinicalinternshipsetting.
H. ProvideseachstudentaCompetencyCheckListsothatthestudentmaypresentthistotheClinical
S facilitytheyareassignedtoduringallinternshipassignments.
I. ConsiderpromptlyanycomplaintmadebytheClinicalSteagainstastudentinaccordancewiththe
SchoolofEMSstandardsandproceduresofdisciplinaryaction.
J. ShallprovidepreceptortrainingtorelevantClinicalSitestaffattheclinicallocation(s) orviaonline
services.
DocuSign Envelope ID: BAC14518-E243-43C0-AD6B-3CADC01D6170
IV. HOLD HARMLESS AND INDMENIFICATION
TheSchoolofEMSagreestoindemnify, defendandholdharmlesstheCityofCarmelanditsofficers, officials,
agents, attorneysandemployeesfromallclaimsandsuitsofwhatevertype, including, butnotlimitedto, allcourt
costs, attorneyfees, andotherexpenses, causedbyanyactoromissionofSchoolofEMSand/orofanyof
SchoolofEMS orstudentsintheperformanceofthisAgreement. These
indemnification obligationsshallsurvivetheterminationofthisAgreement.
V. RESPONSIBILITIES OFTHECLINICAL SITE ANDTHESCHOOLOFEMS
TheClinicalSiteandtheSchoolofEMSshall:
A. AgreeuponthenumberofstudentstobeplacedattheClinicalSiteforclinicalrotations.
B. Reviseandmodifythiscontractinwritingifbothpartiesagreetotherevisionormodification.
VI. TERMINATION
Thiscontractmaybeterminatedbyeitherpartyupononehundredeighty (180) dayswrittennoticetotheother
partybyregisteredmail, returnreceiptrequested. Theterminationshallnottakeeffectuntilstudentswhoare
enrolledatthetimesuchnoticeisgivenhavecompletedthecoursesinwhichtheyareenrolled.
VII. DISCRIMINATION
NeithertheClinicalSitenortheSchoolofEMSshallunlawfullydiscriminateintheirrespectiveperformanceofthis
contract.
VIII. CONTACT PERSONS
ThecontactpersonandauthorizeddesigneeoftheSchoolofEMSforthepurposesofthisagreementis:
Name: VickyLaMay
Title: DirectorofClinicalServices
Email: rcf@schoolofems.org
Address: 115JordanPlazaBlvd.
Tyler, Texas75704
PhoneNumber: (903) 399-1463
ThecontactpersonandauthorizeddesigneeoftheClinicalSiteforthepurposesofthisagreementis:
Name: JonAlverson
Title: EMSChief
Email: jalverson@carmel.in.gov
Address: 2CivicSquare
Carmel, IN46032
PhoneNumber: 317-571-2600
IX. ENTIRE AGREEMENT
ThisAgreementconstitutestheentireagreementbetweentheSchoolofEMSandCitywithrespectto
thesubjectmatterhereof, andsupersedesallpriororalorwrittenrepresentationsandagreements
regardingsame. ThisAgreementmayonlybemodifiedbywrittenamendmentexecutedbyboth
partieshereto, ortheirsuccessorsininterest
DocuSign Envelope ID: BAC14518-E243-43C0-AD6B-3CADC01D6170
EXECUTEDon TheCityofCarmelandtheSchoolofEMShaveexecutedthisagreementbyand .
throughoneofitsdutyauthorizedofficers, therebybindingthemselves, theirsuccessorsandassigneesand
representatives forthefaithfulandfullperformanceofthetermsandprovisionsofthiscontract.
INWITNESS WHEREOF, thepartiesheretohavemadeandexecuted thisAgreement asfollows:
CITY OFCARMEL, INDIANA SCHOOL OFEMS, INC.
byandthroughitsBoardofPublic
Works andSafety
By: By:
James Brainard, Presiding Officer Authorized Signature
Date:
Printed Name
Mary AnnBurke, Member
Date:
Title
LoriS. Watson, Member FID/TIN: 82-4257933
Date:
LastFourofSSNifSoleProprietor:
ATTEST:
Date:
SueWolfgang, Clerk
Date:
DocuSign Envelope ID: BAC14518-E243-43C0-AD6B-3CADC01D6170
2/18/2021
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