HomeMy WebLinkAboutAgreement_General_01/05/2016 AGREEMENT FOR HEALTH CARE SERVICES
This Agreement ( "Agreement ") is made this 5th day of January, 2016, by and between
Jupiter Medical Center Physicians Group, Inc. ( "Provider "), and the Village of Tequesta/
Tequesta Fire Department, Florida ( "Company "), (collectively "Parties ").
RECITALS
Whereas, Provider is in the business of providing Occupational Health Services through
Jupiter Medical Center Urgent Care ( "Urgent Care ") located in the Abacoa Shopping Center at
the corner of Military Trail and Donald Ross Road in Jupiter, Florida; and
Whereas, Company is a municipal corporation existing under the laws of the State of
Florida, which employs numerous individuals; and
Whereas, from time to time, Company's employees require health care services;
Whereas, Provider is willing and able to provide such health care services; and
Whereas, Company desires to provide to its employees the benefit of authorized health
care services as provided by Provider at its Urgent Care location in the Abacoa Shopping Center.
Now Therefore, in consideration of the— mutual covenants and conditions contained
herein, as well as other good and valuable consideration received by the parties, the Provider and
the Company agree as follows:
1. RECITALS The recitals set forth above are true and correct and are hereby
incorporated herein by this reference and shall be considered as part of this Agreement.
2. COMPANY'S OBLIGATIONS
A. Company shall provide or cause to be provided to Provider a referral form that
shall accompany each employee referred to the Urgent Care for health care services. The
requisition shall include the following information:
(i) Employee's full name and date of birth.
(ii) Employee's social security number.
(iii) Employer contact information.
(iv) Name of person authorizing treatment.
(v) Requested services.
(vi) Workers' compensation carrier information, if services are to be
billed to the carrier.
(vii) Instructions for delivery of results.
B. Company shall remit all payments due to Provider within thirty days (30) of
receipt of an invoice from Provider. Invoices shall be submitted monthly and shall identify the
employee and the services rendered. Said invoice will be based on the fee schedule set forth on
Exhibit A, attached hereto and made a part hereof.
3. PROVIDER OBLIGATIONS
A. Except as otherwise specified in this Agreement, with respect to the health care
services, Provider shall provide facilities, equipment, and phlebotomy supplies such as blood
tubes and needles, or other supplies required to provide lab services or urine collection services
to Company.
B. Hard copy reports of drug screens will be provided directly to Company from
the laboratory or medical review officer overseeing any drug screen. Physical exam results will
be forwarded to the Company by fax or mail, per direction of Company at time of referral, within
the same business day that results are known. Work status reports will be provided to Company
and/or workers' compensation carrier on the same day of service. Office notes for workers'
compensation patients will be available to the carrier within seventy -two (72) hours of an
employee's visit.
4. TERM This Agreement shall be for one (1) year commencing on the 5th day of
January, 2016 and shall automatically renew for successive periods of one (1) year each unless
the Agreement is terminated pursuant to Paragraph 5 below.
5. TERMINATION
A. Either Party may terminate this Agreement at any time without cause by giving
the other Party at least thirty (30) days' prior written notice.
B. Neither Party shall have any further rights or obligations hereunder following
termination of the Agreement except: (i) as otherwise provided herein; (ii) for rights and
obligations accruing prior to the effective date of termination; or (iii) arising as a result of any
breach of the Agreement.
6. RELATIONSHIP OF PARTIES Company is not an agent or other representative
of Provider. This Agreement does not constitute a joint venture or partnership between the
Parties.
7. CONFIDENTIALITY
A. The Parties recognize and acknowledge that the Parties hereto may gain access
to certain information of one another, or to information of Company's employees, that is
confidential and constitutes valuable, special and unique property of such Parties or others. As
such, the Parties agree that neither will at any time, either during or subsequent to the term of this
Agreement, disclose to others, use, copy or permit to be copied, without the other Party's, or
other person's applicable express prior written consent, except pursuant to such Party's duties
hereunder, any confidential or proprietary information of the other Party or other individual,
including, but not limited to, information which concerns either Party's employees, patients,
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costs, or treatment methods and which is not otherwise available to the public. The foregoing
shall not apply to: (1) any information received by a Party without breach of this Agreement; (2)
any information which was independently developed by a Party; (3) any information which is
ordered to be released by requirement of a governmental agency, validly served subpoena, or a
court of law; and, (4) any information necessary in connection with Provider's accreditation.
B. Except for disclosure to Company's legal counsel, accountant or financial
advisors (none of whom shall be associated or affiliated in any way with Provider (or any of its
affiliates), Company shall not disclose the terms of this Agreement to any person who is not a
party to this Agreement, unless disclosure thereof is required by law or otherwise authorized by
this Agreement consented to in writing by Provider. Unauthorized disclosure of the terms of this
Agreement shall be a material breach of this Agreement. Compliance with Florida public
records laws shall not be considered to constitute unauthorized disclosure under this Section 7.
C. HIPAA Compliance. The Parties agree to comply with the applicable
provisions of the Health Insurance Portability and Accountability Act of 1996 ( "HIPAA ") and
the requirements of any regulations promulgated thereunder.
D. All provisions of this Section 7 shall survive expiration or other termination of
this Agreement, regardless of the cause of such termination.
8. NOTICES All notices hereunder shall be in writing, delivered personally, by
certified or registered mail, return receipt requested, or by overnight courier, shall be deemed
effective when received, and shall be addressed as follows:
If to Provider: Jupiter Medical Center Physicians Group, Inc.
1210 S. Old Dixie Hwy
Jupiter, FL 33458
Attn: President
With copy to: General Counsel
If to Company: Village of Tequesta and Tequesta Fire Department
345 Tequesta Drive
Tequesta, FL 33469
Merlene Reid
With copy to: General Counsel
or to such other persons or places as either party may from time to time designate by notice
pursuant to this paragraph.
9. PREVAILING PARTY In the event that a suit, action or other proceeding of any
nature whatsoever arises out this Agreement, the prevailing party shall be entitled to recover
from the losing party the prevailing party's reasonable attorney's fees and costs actually incurred
and reasonably necessary in connection therewith, as determined by the judge, in addition to all
other remedies provided by law.
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10. ENTIRE AGREEMENT; MODIFICATION This Agreement contains the entire
understanding of the Parties with respect to the subject matter hereof and supersedes all prior
agreements, oral or written, and all other communications between the Parties relating to such
subject matter. This Agreement may not be amended or modified except by mutual written
amendment executed with the same formality as the original Agreement.
11. GOVERNING LAW This Agreement shall be governed and construed in
accordance with the laws of the State of Florida with venue in the courts of Palm Beach County.
12. COUNTERPARTS AND FACSIMILES This Agreement may be executed in
counterparts, each of which shall be deemed an original, but all of which shall collectively
comprise one agreement. Facsimile copies of this Agreement and the signatures hereon shall be
considered for all purposes as originals.
13. WAIVER A waiver by either Party of a breach or failure to perform hereunder
shall not constitute a waiver of any subsequent breach or failure.
14. ASSIGNMENT; BINDING EFFECT This Agreement is not assignable without
the prior written consent of the Parties.
15. INSPECTOR GENERAL. Pursuant to Article XII of the Palm Beach County
Charter, the Office of the Inspector General has jurisdiction to investigate municipal matters,
review and audit municipal contracts and other transactions, and make reports and
recommendations to municipal governing bodies based on such audits, reviews, or
investigations. All parties doing business with the Village shall fully cooperate with the inspector
general in the exercise of the inspector general's functions, authority, and power. The inspector
general has the power to take sworn statements, require the production of records, and to audit,
monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists
of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement,
misconduct, and abuses.
16. PUBLIC RECORDS In accordance with section 119.0701, Florida Statutes, the
Company must keep and maintain this Contract and any other records associated therewith and
that are associated with the performance of the work described herein. Upon request, the
Company must provide the public with access to such records in accordance with access and cost
requirements of chapter 119, Florida Statutes. Further, the Company shall ensure that any
exempt or confidential records associated with this Contract or associated with the performance
of the work described herein are not disclosed except as authorized by law. Finally, the Company
shall retain the records described in this paragraph throughout the performance of the work
described herein, and at the conclusion of said work and upon request, transfer to the Village, at
no cost to the Village, all such records in the possession of the Company and destroy any
duplicates thereof. Records that are stored electronically must be transferred to the Village in a
format that is compatible with the Village's information technology systems.
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IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the
date first written above.
Provider: Company:
JUPITER MEDICAL CENTER VILLAGE OF TEQUESTA and
PHYSICIANS GROUP, INC. TEQUESTA FIRE DEPARTMENT
_.
Judy Magalhaes, Vice President Michael Couzzo, Jr., Village Manager
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IAi WI1'NESS WHLRNAF, the Fa=ti� hereta �ave exec�te� thia A�t as of the
date fir�written above.
Frovider: Company:
JUPIfER MCI?1CAL CF.I�TER VILLAGE OF TEQUFSTA anci
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By: B�d:.r..�"`: -
MagaIh Vic�President Mi�tael Cau�a.o,Jr illa� +er
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EXHIBIT A
FEESCHEDULE
OCCUPATIONAL HEALTH SERVICES
Phone: 561 - 745 -5787 / Fax: 561 - 745 -5713
Village of Tequesta
357 Tequesta Drive
Tequesta, F133469
September 3, 2015
Dear Pat,
As requested, Jupiter Medical Center /Occupational Health Services is happy to perform the following services for
the Village of Tequesta Fire Rescue. To follow please find a schedule of fees for your consideration.
Fee Schedule
Complete History & Physical Examination $50.00
Urine Heavy Metal (Arsenic, Mercury, Lead) $52.08
Urinalysis $3.75
Hepatitis B Surface Antibody $20.00
RPR $4.50
HIV $25.00
Comprehensive Metabolic Panel $6.00
Lipid Panel $9.00
CBC $5.00
RBC Cholinesterase $30.00
12 Lead EKG (with Cardiologist Interpretation) $55.00
Audiometry (by certified hearing conservationist) $45.00
Spirometry $45.00
PPD $10.00
Chest Xray (with Radiologist Interpretation) $50.00
*Arsenic Fractionation (send out lab -only if elevation) $160.00
OTHER ITEMS:
*Hepatitis B vaccine (only If indicated) $80.00 / each
* Urine Drug Screen (New Hires/Random or Reasonable Suspicion) $40.00
*Breath Alcohol (BAT) (Random or Reasonable Suspicion) $40.00
Sincere thanks,
Susan Mosley, RN
Nurse Manager