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HomeMy WebLinkAboutAgreement_General_12/14/2017_Jupiter Medical Center Physicans Group AGREEMENT FOR HEALTH CARE SERVICES This Agreement for Health Services(this"Agreement")made this 5t'day of January, 2018 ("Effective Date")by and between Jupiter Medical Center Physicians Group, Inc. ("Provider")and Village of Tequesta/Tequesta Fire Department, Florida("Company"). RECITALS Whereas, Provider is in the business of providing health care 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; Whereas, from time to time Company's employees need health care services which are available at the URGENT CARE; and, Whereas, Company desires to have its employees receive Company-requested health care services by Provider at its URGENT CARE location. Now therefore, in consideration of the recitals set forth above and the covenants and conditions contained herein,the parties agree as follows: 1. RECITALS. The recitals set forth above are true and correct and shall be incorporated herein by this reference and considered in the interpretation 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 the specific health care services from Exhibit A hereto which are requested by the Company. The referral form 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) The Requested services from Exhibit A. (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. Invoices shall be sumitted monthly and shall identify the employee(s) and the date(s) and type(s) of services rendered. Said invoices 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 any of the lab services or urine collection services as requested by Company for its employees. 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 commence on the Effective Date and shall expire at 5:OOpm Eastern time on the next-occuring September 30`h (the "Expiration Date"), unless the parties renew the Agreement by signing an Annual Renewal Addendum in the form attached herewith as Exhibit B. Failure of Company to sign and return the Annual Renewal Addendum to Company on or before the Expiration Date shall result in termination of this Agreement on the Expiration Date. 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 (e.g.. fees due to Provider for services rendered prior to the termination date); or (iii) arising as a result of any breach of the Agreement. 6. RELATIONSHIP OF PARTIES. Neither party is an agent or representative of the other party under this Agreement. 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 that is confidential and constitutes valuable, special and unique property of such party. As such, each party agrees that it will not 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 express prior written consent, except pursuant to such party's duties hereunder, disclose any confidential or proprietary information of the other party, including, but not limited to, information which concerns either party's employees, patients, 2 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. 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 Attn: Merlene Reid 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. 10. ENTIRE AGREEMENT; MODIFICATION. This Agreement, including any attachments hereto, contains the entire agreement of the parties hereto and supersedes all prior 3 and contemporaneous oral or written negotiations, representations, agreements, understandings, proposals, or undertakings with respect to the subject matter hereof, all of which are deemed incorporated and merged into this Agreement or abandoned. This Agreement may only be modified or amended by the mutual written agreement of the parties. Any such modification or amendment shall be signed by authorized representatives of each parry and shall be attached to and become part of this Agreement. 11. GOVERNING LAW. This Agreement shall be construed in accordance with the laws of the State of Florida with venue in the courts of Palm Beach County. 12. COUNTERPARTS AND FACSIMILES. The parties hereto may execute this Agreement in any number of separate counterparts (including by confirmed electronic, email, and/or facsimile transmission), each of which, when executed shall be deemed and original, and all of which,when taken together, shall constitute one and the same instrument. 13. WAIVER. Any failure of one party to enforce its rights under this Agreement shall not be construed as contemporaneous or future waiver of such rights (or any other rights) herein. No waiver of any breach or failure to enforce one or more of the terms and conditions hereof shall be construed as an implied amendment or agreement to modify or as a waiver of the right to later enforce, such terms. If any provision of this Agreement is held invalid, then to the fullest extent permitted by law, such invalidity shall not affect the validity of any other provision of this Agreement. 14. ASSIGNMENT: BINDING EFFECT. This Agreement is not assignable without the prior written consent of the parties. 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 TEQUESTA FIRE PHYSICIANS GROUP, INC. DEPARTMENT B . By: J dy aalh Vice President 4 EXHIBIT A SERVICES AND FEES SCHEDULE SERVICE FEE Complete Medical History and Physical Examination by Provider $70.00 Urine Heavy Metal $70.00 Urinary Analysis $ 12.50 Hepatitis B Surface Antibody(titer) $22.00 RPR Screening $ 8.00 HIV Screening $25.00 Comprehensive Metabolic Panel $ 17.00 Lipid Panel $20.00 Complete Blood Count with Differential $ 12.00 RBC Cholinesterase $32.00 EKG with Cardiologist Interpretation $55.00 Audio Test $55.00 Pulmonary Function Test $55.00 PPD (Tuberculosis Test) $20.00 Chest x-ray(PA and lateral)with radiologist interpretation $75.00 Aresnic Fractionation $75.00 Hepatitis B Vaccine $85.00/each Urine Drug Screen(collection,testing, MRO) $40.00 Breath Alcohol with or without confirmation $45.00 Management of Workers' Compensation injuries is also provided from initial injury through return to work. Fees are based on the State of Florida mandated fee schedule. 5 EXHIBIT B ANNUAL RENEWAL ADDENDUM RENEWAL YEAR OCTOBER 1,20_through September 30,20 This Annual Renewal Addedum ("Addendum")relates to that certain Agreement for Health Services (the"Agreement") dated , 20 by and between Jupiter Medical Center Physicians Group, Inc. ("Provider") and ("Company"). This Addendum must be signed by Company and returned to Provider on or before September 30th, 20 In consideration of the mutual promises and covenants herein contained, and for other good and valuable consideration,the receipt and sufficiency of which are hereby acknowledged, the parties hereto herby agree as follows: 1. The Agreement shall be renewed for the October 1 through September 30 Renewal Year set forth in the title of this document. 2. The Services and Fees Schedule on Exhibit A of the Agreement shall: a. REMAIN THE SAME AS THE PRIOR YEAR; or b. Be deleted in their entirety and replaced with the new Services and Fees set forth on Exhibit A attached herewith and incorporated into the Agreement by this reference. 3. Except as otherwise set forth in this Annual Renewal Addendum,the Agreement shall remain in full force and effect in accordance with its terms. IN WITNESS WHEREOF, in signing below, and intending to be legally bound thereby, the parties hereto hereby agree to the foregoing, which shall take effect as of the first day of the Renewal Year set forth in the title of this document. P.Le- met l.e" Provider: Company: 3-6 1 -e X. 6 JUPITER MEDICAL CENTER Shan t ✓1D-1' 6t-. PHYSICIANS GROUP, INC. S 'S nod By: By: Judy Magalhaes, Vice President [Insert Name] 6 EXHIBIT A To Annual Renewal Addendum SERVICES AND FEES SCHEDULE [To be completed by Provider in the event that the existing Exhibit A to the Agreement must be updated to reflect new Services and Fees to be offered to Company by Provider as part of a renewal of the Agreement.] 7