HomeMy WebLinkAboutIU Health/CPD/2023 Affiliation Agreement AmendmentIU Health Inc. – Amendment Letter Template – 09.25.2023
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AMENDMENT OF AGREEMENT
This document serves as an amendment (“Amendment”) of the Affiliation Agreement (original
commencement date of July 1, 2023, and original termination date of June 30, 2024) (the “Affiliation
Agreement”) between Indiana University Health, Inc. and City of Carmel, an Indiana municipal
corporation, by and through its Board of Public Works and Safety (“City”).
The Parties desire to amend the Affiliation Agreement to update certain responsibilities as set forth herein.
1. Definitions. Capitalized terms used in this Amendment but not defined in this Amendment will have
the meanings assigned to them in the Affiliation Agreement.
2. Section III School Responsibilities - Section (III)(H)(3) of the Affiliation Agreement is deleted and
replaced with the following:
“Receive the following vaccinations: measles, mumps, rubella, varicella, tetanus, diphtheria,
pertussis, and Hepatitis B (or Hepatitis B vaccination declination form on file) or shows appropriate
antibody titer. Annual influenza vaccination is also required unless an exception is granted based
on medical or religious grounds. An exception to the influenza vaccination granted by School must
be submitted as requested by IU Health in advance of the first day of the student’s rotation at an IU
Health Facility.
Students are strongly recommended to be fully vaccinated against COVID-19. IU Health is required
to track COVID-19 vaccination rates, and all vaccinated individuals in IU Health facilities are asked
to submit documentation using the online form provided by IU Health.”
3. Section III School Responsibilities - Section (III)(H)(4) of the Affiliation Agreement is deleted and
replaced with the following:
“Screen negative for active TB within 12 months of starting the initial IU Health rotation. The
student must also submit a TB questionnaire completed within 90 days prior to initial IU Health
rotation, regardless of the testing protocol followed.
a. If a student denies history of a positive IGRA test or a previous reaction to TST,
proceed with desired method of testing.
If IGRA blood testing is being used for the student within 12 months of clinical
rotation, with the TB questionnaire being completed within 90 days prior to the
start of the rotation, the student has met the TB screening requirements if the IGRA
is negative.
If TST is being used by the student, a 2-step TB skin test is required within the last
year with the TB questionnaire being completed within 90 days prior to the start
of the rotation.
If there is no TB skin test within the last 12 months, Step 1 must be done before
the start of the rotation and Step 2 will be done 2-4 weeks later or requirement may
By Jon Oberlander at 2:52 pm, Oct 17, 2023
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IU Health Inc. – Amendment Letter Template – 09.25.2023
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be completed with IGRA test. The student may be cleared prior to receiving the
2nd step as long as the 1st Step is negative.
A documented test within the last 12 months will be accepted as Step 1 TST. If
Step 1 TST is acceptable then Step 2 TST or IGRA will be done before the rotation
starts.
b. If a student has a reliable history of positive TST:
A baseline IGRA must be drawn.
If baseline IGRA or reliable history of IGRA is positive a baseline chest x-ray will
be required. A post conversion chest x-ray film within the past 2 years will be
accepted or ordered as a baseline unless the student will be rotating through Home
Care or Hospice, in which case the chest films must be within the past 12 months.
The student should consult with their Primary Care Physician (PCP) for any
questions concerning symptoms.
If student has a history of a positive TST or IGRA an annual questionnaire is
required unless TB Treatment has been completed.”
4. No Other Modifications. Except as otherwise set forth in this Amendment, all other provisions of the
Affiliation Agreement shall remain unchanged.
5. Effective Amendment. The changes described herein shall commence on October 1, 2023. The Parties
agree that this Amendment has been duly prepared and executed in accordance with the terms of the
Affiliation Agreement and will be considered part of the Affiliation Agreement once signed by all
Parties.
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
BY:
James Brainard, Presiding Officer
Date:
Mary Ann Burke, Member
Date:
Lori S. Watson, Member
Date:
ATTEST:
Sue Wolfgang, Clerk
Date:
DocuSign Envelope ID: 25871783-397A-4D54-A3EA-553F47642B67
Not Present
N/A
10/18/2023
10/18/2023
10/18/2023
IU Health Inc. – Amendment Letter Template – 09.25.2023
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INDIANA UNIVERSITY HEALTH, INC.
By: Date
Greg Strine MA, RN
Executive Director
Office of Academic Affairs
IU Health
DocuSign Envelope ID: 25871783-397A-4D54-A3EA-553F47642B67