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HomeMy WebLinkAboutIU Health/CFD/Renewal to Affiliation AgreementRENEWAL TO THE AFFILIATION AGREEMENT This document serves as a Renewal tothe Affiliation Agreement (original commencement date of July 1, 2023, and original termination date of June 30, 2024) between Indiana University Health, Inc. and City of Carmel, an Indiana municipal corporation, by and through its Board of Public Works and Safety (City). Once signed by all parties, the termination date of the affiliation agreement (original agreement plus any and all addendums/amendments/renewal letters previously signed) will be June 30, 2025. CITY OF CARMEL, INDIANA By and Through its Board ofPublic Works and Safety By:Date: Sue Finkam, Presiding Officer By:Date: Laura Campbell, Member By:Date: Alan Potasnik, Member By:Date: Jacob Quinn, Clerk INDIANA UNIVERSITY HEALTH, INC. IU Health 2-21-2024By:Date: Greg Strine, MA, RN Executive Director of Academic Affairs IU Health Inc. Renewal Letter Template – 1.16.2024 Page 1of1 DocuSign Envelope ID: 290B1E51-8081-443A-993D-E406C409B607 5/15/2024 5/15/2024 NOT PRESENT 5/15/2024 CzKpoPcfsmboefsbu3;63qn-Pdu28-3134AMENDMENTOFAGREEMENT Thisdocument serves asanamendment (“Amendment”)oftheAffiliation Agreement (original commencement dateofJuly1, 2023, andoriginal termination dateofJune30, 2024) (the “Affiliation Agreement”) between Indiana University Health, Inc. and CityofCarmel, anIndianamunicipal corporation, by andthrough its Board ofPublic Works andSafety (“City”). TheParties desire toamend theAffiliation Agreement toupdate certain responsibilities asset forthherein. 1.Definitions. Capitalized terms usedinthisAmendment butnotdefined inthisAmendment willhave themeanings assigned tothemintheAffiliation Agreement. 2.Section IIISchool Responsibilities- Section (III)(H)(3) oftheAffiliation Agreement isdeletedand replacedwiththe following: Receive thefollowing vaccinations: measles, mumps, rubella, varicella, tetanus, diphtheria, pertussis, andHepatitis B (orHepatitis Bvaccination declination formonfile) orshows appropriate antibody titer. Annual influenza vaccination isalsorequired unless anexception isgranted based onmedical orreligious grounds. Anexception totheinfluenza vaccination granted bySchool must besubmitted asrequested byIUHealth inadvance ofthefirst dayofthestudent’srotation atanIU Health Facility. Students arestrongly recommended tobefullyvaccinated againstCOVID-19. IUHealth isrequired totrack COVID-19vaccination rates, andallvaccinated individuals inIUHealth facilities areasked tosubmit documentation using theonline form provided by IUHealth.” 3.Section III School Responsibilities- Section (III)(H)(4)oftheAffiliation Agreement isdeletedand replacedwith thefollowing: Screennegative foractive TBwithin 12months ofstarting theinitial IUHealthrotation. The student must alsosubmit aTBquestionnaire completed within 90daysprior toinitial IUHealth rotation, regardless ofthetesting protocol followed. a. Ifastudent denies history ofapositive IGRA test oraprevious reaction toTST, proceed withdesired methodoftesting. IfIGRA blood testing isbeing used forthestudentwithin 12months ofclinical rotation, withtheTBquestionnaire being completed within 90daysprior tothe startoftherotation, thestudent hasmettheTBscreening requirements iftheIGRA isnegative. IfTSTisbeing usedby thestudent, a2-stepTBskintest isrequired within thelast yearwiththeTBquestionnaire being completed within 90daysprior tothestart oftherotation. Ifthere isnoTBskintestwithin thelast12months, Step1must bedone before the startofthe rotation andStep2willbedone2-4weeks laterorrequirement may IU Health Inc. – Amendment LetterTemplate – 09.25.2023 Page 1of3 DocuSign Envelope ID: 290B1E51-8081-443A-993D-E406C409B607 becompleted withIGRA test. Thestudent maybecleared prior toreceiving the ndst2stepaslongasthe1Stepisnegative. Adocumented testwithin thelast12monthswill beaccepted asStep1TST. If Step1TSTisacceptable then Step2TSTorIGRA willbe donebefore therotation starts. b. Ifastudent has areliable history ofpositive TST: Abaseline IGRA mustbedrawn. Ifbaseline IGRA orreliable history ofIGRA ispositive abaseline chest x-raywill berequired. Apostconversion chest x-rayfilmwithinthe past2years willbe accepted orordered asabaseline unless thestudentwill berotating through Home Care orHospice, inwhich casethechest films must bewithin thepast12months. Thestudent should consult with theirPrimary Care Physician (PCP) forany questions concerning symptoms. Ifstudent has ahistory ofapositive TST or IGRAanannual questionnaire is required unless TBTreatment hasbeencompleted.” 4. NoOther Modifications. Except asotherwise setforth inthisAmendment, allother provisions ofthe Affiliation Agreement shallremain unchanged. 5. Effective Amendment. Thechanges described herein shallcommence on October 1, 2023. TheParties agreethat thisAmendment hasbeendulyprepared andexecuted inaccordance withtheterms ofthe Affiliation Agreement andwillbe considered partoftheAffiliation Agreement once signed byall 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: IU Health Inc. – Amendment Letter Template – 09.25.2023 Page 2 of3 DocuSign Envelope ID: 290B1E51-8081-443A-993D-E406C409B607 INDIANA UNIVERSITY HEALTH, INC. By: Date Greg Strine MA, RN Executive Director Office ofAcademic Affairs IUHealth IU Health Inc. – Amendment Letter Template – 09.25.2023 Page 3 of 3 DocuSign Envelope ID: 290B1E51-8081-443A-993D-E406C409B607