HomeMy WebLinkAbout05537 - AMERICAN MEDICAL RESPONSE FIELD INTERNSHIP EXPERIENCE Kathie Hart
From: Judy Blumberg
Sent: Tuesday, May 07, 2013 1:53 PM
To: Kathie Hart
Cc: John Allen
Subject: American Medical Response - NCTI Contract
Document#A5537 -this will not be renewed.
094OB&M69%d¢"&W tatzM 04""tant
d6hn 8p"-i OFLtaOapatbnant
300 dK 06&&01tvad
L-Pahn epthW eof 92262
(760)JEM787
AFFILIATION AGREEMENT FOR FIELD INTERNSHIP EXPERIENCE
TMS AFFILIATION AGRF,FMFNT FOR FIELD malriculalion, promotion and graduation and shall be
iNTERNSFIIP EXPERIENCE is made between American approved or accredited by relevant licensing/cenifying
Medical Response West, d/b/a Northern California Training agencies in the state(s) and county(ies) in which
Institute,("School")and the Contractor(the"Contractor')set out School resides and in which the program contemplated
on The signature page of this Agreement herein is to operate.
WHEREAS, School is a program which osiers a program of 2.2. Approval by Licensing/Certifying Agency(ic%).
instruction leading to certification or licnnsure of its students as School shall secure from all relevant
Zinorgeney Medical Technician,Emergency Medical Technician- liccnying/ecrtifying agencies written approval for the
Paramedic and other, similar health care and prc-hospital Field Internship Experience program contemplated
providers("Students"), herein and shall maintain such approval throughout
the course of The program. School shall provide
WHEREAS, As a part of the licensing and/or certification Contractor with a copy of the written approval and
requirements Students must complete a courbc of study including — applicable guidelines or protocols applicable to the
a field intcmbhip experience ("Field Internship Experience') by program before asmgnfng a Student to the Field
and through assignment to various mobile intensive care units Internship Experience program.
operated by Contractor;
2.3. StudenT Lieensnre/CerNScatian. School shall
WHEREAS, Contractor is a provider of emergency medical ensure that each Student enrolled in the clinical
service, including both advanced life support and basic life program is compliant with any hcensure certification
support prc-hospital care and transport, and Contractor has required for participation in this program,which may
agreed to assist School by providing a limited Field internship include, but is not limited to state EMT and CPR
Experience for Students, upon certain terms and conditions, so credentials or any provisional liccnsure/ccr(ificativn,
long as its participation in the progranh does not jeopardize School shall providc Contractor with a copy of the
patient care or compromise Contractor's standards of service to requisite liccnsure and or curiication for any Student
its patients enrolling in the Field Intemyhip Experience before the
Student is allowed to participate in the program
NOW THEREFORE, in consideration of the foregoing and for unless,the licensing/certifying agencies advise Schaal
other good and valuable consideration, the receipt and sufficiency and Contractor, in writing,that licensure/certification
of which arc hereby acknowledged, the parties hereto agree as is not required and the Field Internship Experience
follows: program is approved under all applicable, or
potentially applicable,laws and mgulationb.
1. TERM.
2.4. Approval by Doctor or Agency Having Medical
1.1, Commencement Date. This agreement shall become Control. If applicable, School will secure from the
effective when signed by all of the parties("Effective doctor or agency having medical control in the statc(s)
Dare") and completion of the written approval and or county(ics) in which program will operate, written
certification contemplated in paragraph 2.2, 2.3 and approval for the Field Internship Experience. Such
2.4. This agreement shall be for a term of twenty-four written approval shall,at a minimum,define the scope
(24) months from the Effective Date. Any renewal of practice and required supervision of any Studcnt
shall be set fords in a writing signed by the panics School will in the course of clinical pducatw e
School will provide Contractor with a copy of The
1.2. Termination, This agreement may be terminated by approval contemplated in this paragraph before
either party, with or without cause, upon thirty (30) assigning any Strident to the clinical program.
days written notice to the other party ab provided 2,-5. Records. School will keep and maintain accurate
herein. records for all Students participating in the Field
2. RIGHTS AND OBLIGATIONS OF SCHOOL Internship Experience. The records will include the
Students transcript, liccnsure or certification.
2.1. School's Accreditation School shall mainlain a temporary license or certification (if applicable), pre"
qualified educational program for Studcntb designed to a4scbsmenl health record, and record of history /
providc a smooth transition into liccnsure/certitication vaccination / immunization as set Forth in paragraph
of Students as Emergency Medical Technicians, 2.8 hereof. School will maintain tile records For a
Emergency Medical Technician-Paramedics or oiler period of at least four(4)years (or any greater period
similar pre-hospital health cart providers. School'b as may be required by applicable) from the date
program shall include programming, administration,
Student completes, or ceases to participate in, The equipment must be in the possession of the Student as
Field Internship Experience contemplated herein. a condition of their participation in the program.
Failure to possess and use The required OSHA
2.6- List of Participants, Qualifications, Objectives and equipment will result in Student's dismissal from the
Representations. School will notify Contractor at program.
least thirty(30)days prior to the inception of a course
of Field Intcroship Experience of the names, 2.11. Assistance in Obtaining Signatures and
qualifications and performance objectives for each Compliance, School recognizes that its Stndcnts have
Student scheduled to begin their Field intemship certain obligations and will be required to execute
Experience. inclusion by School of a Student's name certain documentation in order to be eligible to
on this list is School's representation that the Student participate in the program. School shall assist
possesses the necessary skills, llccnsure/certification Contractor in obtaining any necessary signatures and
and immunizations to engage in the Field Internslhip ensuring Studer compliance with Contractor rules
Experience. The School shall comply wish any and this agreement including, but not limited to.Those
requirements or procedures Thai Contractor requires contained in part 3 of this agreement.
regarding documentation To verify the Student's
qualifications for the Field Internship Experience 2.12. Evaluation of Performance. School, in conjunction
with Contractor personnel, is responsible for and shall
2.7. Contractor Rulcs and Regulations School will use make arrangements for evaluating Student's
all reasonable efforts to cause Students to comply with performance during the clinical program.
Contractor's policies, procedures. work rules and
rcgulations, including prescrvahon of the 2.13. Minimum Age of Participants. School and
confidentiality of-patient care and patient care records. Contractor will only allow Students that are at least
School will, prior to allowing a Student to participate eighteen (18) years of age to participate in this
in the Field Internship Experience, review patient program. inclusion of a Student's name on the list
confidentiality as well as the Contractor's policies, referenced in paragraph 2.6 is School's representation
procedures, work rules and regulations with Student thar Student is at least eighteen(18)years of age.
and secure Student's agrccmcm to abide by all such
rules and rcgulaliont. 3- STUDENT OBLIGATIONS AND REQUIREMENTS.
2.8. Pre-assignment Health Assessment. School will 3.1. Release. Student will, prior to participating in the
cause Student to complete a pre-assrgmnem health clinical experience, read, understand and sign a ride-
assessment, at Student's or School's expense, which along waiver releasing Contractor from any and all
includes, but is not limilcd lo- history of liability and/or responsibility arising out of Student's
communicable diseases and immunival'ionS, proof of participation in the Clinical Experience. This release
tetanus vaccination or immunization, proof of of claims must be executed, and on file with the
Hepatitis B vaccination or executed declination and School, prior to Student participation in the program.
waivers of The Hepatitis B vaccination by the Student, The release is a condition prcccdcnt to Student's
proof of MMR vaccination,respirmory certification by participation in the clinical experience and no Student
a physician and PPD test. School will provide proof will be permitted on a Convactor vehicle without
of satisfactory complctron/vaccination to Contractor having signed The release. the release is anached
upon request.Inclusion of a Student's name on the list hereto and made a part hereof as Exhibn A.
referenced in paragraph 2.6 is School's representation
that Student has completed the pre-ass'ignmcnt 3.2. Pvc-assignment Health Assessment. Snider shall
assessment and Is physically able to perform the tasks complete a pre-assignment health assessment as set
associated with the program. forth in paragraph 2.8 hereof.
2.9. OSHA Compliance Prior To allowing Snrdent to 3.3. Contractor Rules and Patient Confidentiality.
cmoll in the course of Field Internship Experience, Student shall comply with Contractor's procedures,
School will educate and train Studer in compliance policies, rules and regulations, including maintenance
with all relevant and required OSHA rcgulations of patient and records confidentiality Students, while
including, but not limited to. Blood-home Pathogens participating in the clinical program, on Contractor
Standard and TJ3 Standard property, must meet all standards of appearance and
conduct required by Contractor of its own employees.
2.10- Personal Protective Equipment, School shall Student shall comply with all applicable OSHA rules
provide Student with all necessary personal protective or regulations. Student shall have in their possession
equipment,including fining,as is,or may be,required at all times when on board a Contractor vehicle
by OSHA or other regulatory agency as required in personal protective equipment and use such equipment
locale of Contractor prior to assignment to the Field when, as and where designated by Convactor
Internship Experience. Such equipment may include personnel, Any information generated as a result of
safety glasses, face shields and pariculare respirators. the activities set forth in this agreement, including
School recognizes and will inform Student Thar this information regarding patients or business activities of
2
4.6. Student Evaluations. Contractor will cooperate with
School to performing evaluations of Student's Field
Internship Experience.
4.7. Provision of Field Internship Experience.
Contractor will provide a Field Internship Experience
for the School's Students in compliance with the
guidelineY, protocols. scope of practice provided by
the hcensmg/ccrti tying agency and in accord with the
3.4. Student Intern Agreement. Student will read and Instructions of the doctor or agency having medical
execute the student intern agreement, Execution of control, if applicable. The number of Students that
the student intern agreement is a condition precedent Contractor accepts into the Field Internship
to participation in the Field Internship Experience Experience shall be determined by mutual agmcmcnt
program. The student intern agreement is attached between School and Contractor.
hereto and made a part hereof as Exhibit A.
5. iNDEMNTFICATION
4. CONTRACTOR RIGHTS AND OBLIGATIONS.
5.1. Indemnity for Third Party Claims. School will
4.1. Contractor Rules. Contractor requires Students, save,defend,indemnify and hold hamtcss Contracor,
while participating in the clinical program, on its officers, employees, agents, affiliates and
Contractor property, to meet all standards of representatives of and from any and all claims, Suits,
appearance and conduct required by Contractor of its costa and actions arising out of the provision of the
own employees Contractor reserves the right to Field Internship Experience. This indemnity shall
refuse to allow any Student to participate in the survive and remain enfomwbic after the expiration or
clinical program for failure to comply with Contractor termination of this Affiliation Agreement, provided
standards. however, that this indemnity is not intended to cover
claims against Contractor wibino solely out of
4.2_ Student's Skill Level. Contractor reserves the right Contractor's own negligence or intentional conduct,
to discontinue Student's participation in the program
should Contractor,m its sole discretion,determine that 5.2. indemnity for Student Claims. School will save,
Student's skill level is substandard Contractor will defend, indemnify and hold harmless Contractor, its
immediately advise School of any such concerns or officers, employees, agents, affiliates and
situations. representatives of and from any and all clanns, suits,
costs and actions brought by any Student, or their
4.3- Orientation Program. Contractor may require heirs, against company arising out of their
Student to attend an orientation program designed to participation in this program or by any patient
orient Student to Contractor's rules regulations and claiming that the negligence of Student caused,
policies prior to beginning their Field Internship compounded or exacerbated their injuries. This
Experience. The details and procedures for the indemnity shall survive and remain enforceable after
orientation program bhall be in the Contractor's sole the expiration or termination of this Affiliation
discretion. Agreement; provided, however, that this indemnity is
not intended to cover claims against Contractor wising
4.4. Contractor's Control of Patient Care. Contractor solely out of Contractor's own nugligcncc or
reserves the right to determine where, when and if a intentional conduct.
Student may participate in the provision of care to its
patients. Contractor will endeavor to utilize Student. 5.3. Defense Obligation. In any action in which Schaal is
and allow them to utilize as many of their skills in as obligated to provide Contractor with a defense,School
many situations as possible. However, patient care is shall at its cost and expense, fully and diligently
paramount and Student shall follow Contractor's defend Contractor against any claims brought,
instructions with respect to the provision of patient investigations undertaken or actions Fled which
care concern claims for which Contractor is entitled to
indemnification under paragraphs 5.1,5.2,and 5.3.
4-5, Right to Control Participation. Company reserves
the right to refuse to allow any Student to participate 6. INSURANCE.
in the provision of care at the scene of wi emergency
where, in company's sole discretion, permitting 6-1. Professional Medical Liability and General
Student to participate would endanger the Student, a Liability Coverage School will maintain
paricnt or an employee of Company or otherwise be Professional Medical Liability and General Liability
inappropriate. coverage of not less than one million dollars
(51,000,000.00) per occurrence and three million
dollars (53.000,000.00) aggregate. Coverage must
,specifically cover Students in the Field Internship
3
Expuricncc, working under This agreement and within verifcation of receipt Notice shall be sent to the
the course of their training and education during Chit following addresses:
program, School will name Contractor as an
Additional insured under the policy and include an Ifto Contractor:
indemnification provision, by endorsement, to be
atrached to the certificate of insurance School will Palm Sprinp4 Firc Department
provide Contractor with written verification of 300 N.Cielu Road
coverage In the form of a ourtificatc of insurance, fain Springs,CA 92262
which will be attaehud to this agreement. School
covenants to keep the required insurance in force and lfto School:
effect through the term of this agreement and maintain
tail coverage for five (5) year$ thereafter if the American Medical Response West.
coverage was a"clams made"policy. dPo/a Northern California Training institute
333 Sunrise Avenue,Suite 500
6.2. Endorsement for Student Activities. School assures Roseville.California 95661
Contractor that all coverage of insurance required
herein includes specific provisions and/or With Mandatory Copy to:
endorsements to include Students within School's
Medical Liability and General Liability coverage for Legal Dopartmcnt
all activities conducted under this program. American Medical Response,Inc
6200 South Syracuse Way,Suite 200
6-3- Coverage for Student Injuries. School recognizes Greenwood Village,Colorado Ul I I
thal Students arc N0f covered by Contractor's
Workers Compensation Insurance or Self Insured S. Fees,Compensation and Tuition
Program. School represents and warrants that it will
maintain, or ensure that its Students arc covered, Far 8.1. pees, Compensation and Tuition. If applieablc, any
bodily injury and disease should any Student be fees, compensation and tuition thin Contractor shall
injured or became ill dining the course of then-Field receive will beset forth in Exhibit h3.
Internship Experience. School will provide Contractor
with a written verification of insurance coverage in the
form of a certificate of insurance which will be 9• Scope of field internship Experience
attached to this agreemenl,
9A, Scope of Field internship Experience. The specife
6.4. Amount of Coverage Not a Limitation. The amount scope of the Field Internship Experience that the
of insurance required hereunder shall not limit Contractor shall provide will be sit forth in Exhibit C.
School's liability nor relieve School of any obligation
hereunder. 10. MISCELLANEOUS.
6.5. Minimum Qualifications of Insurer. Any policies of 10-1. Miscellaneous. This Agreement (including the
insurance shall be maintained with insurance Schedules and Exhibits hereto): (a) constitutes the
companies: (i) holding a "General Policyholder's entire agreement between the parties with respect to
Rating" of AIV or better, as set forth in the mosr the subject matter hereof,superseding all prior oral or
currcm issue of "Best's Tnwrancc Guide," on written agreements with respect thereto; (b) may be
comparable rating from reputable rating organizations, amended only by written instrumenr executed by both
(ii)licensed to operate and sell insurance in the state in parties. (c) may not be assigned by either party
which the Field Internship Experience will occur; and without the written consent of the other party, such
(ui)in good standing and admitted,if applicable,with eun$ent not to be unreasonably withheld; (d) shall be
the states Department of Insurance or other similar binding on and more to the benefit of the parties
regulatory agency in the stare in which the Field hereto and their respective successors and permitted
Internship Rxpericncc will occur assigns; (c) shall be interpreted and enforced In
accordance with the laws of the State of the principal
7. NOTICES. ellToe of the SCIrIOI, without regard to the conflict of
laws provisions thereof, and the Federal laws of the
7.1. Any notice required of permitted by this Agreemcnt Unnred Stares applicable therein; (f) this Agreement
shall be in writing and shall be delivered as follows, may be executed in several counlerparts(including by
with notice deemed given as indicated:(a)by personal facsimile), each of which shall constitute an original
delivery, when delivered personally; (b)by overnight and all of which,when taken together, shall constitute
courier, upon written verification of receipt; (c)by one agreement; and (g) this Agreement shall not be
facsimile transmission, upon acknowledgment of effective until executed by both panes.In the event of
receipt ofclactromc transmission,or(d)by certified or a dnsagrecmenr between this Agreement and any
registered mail, return rcccipt requested, upon Schedule hereto, the terms of this Agreement shall
govern,
4
11. Other.
11.1. Compliance with Laws. The parties will comply in
all material respects with all applicablc fcdcral and
state laws and regulations including, the federal Anti-
kickback stature.
11.2. Compliance Program and Code of Conduct. The
Contractor acknowledges That School has made
available to School a copy of its Compliance Program
and Code Of Conduct at School's web site. located at:
www.amr.net. The School shall comply with any
training requirements that may be legally imposed
upon School by any applicable regulatory authority.
11.3. Non-Exclusion. Each party represents mid certifies
that it has not been convicted of airy conduct identified
on Exhibit D Each party further represents mid
certifies that it is not ineligible to participam in
Federal health care programs or in any other stale or
federal government payment program, us provided on
Exhibit D or otherwise. Each party undcrslands that
if DHHS or OIG excludes it, of any of its employees
who provide health cue services,fiom participation in
Federal health care programs,the party must notify the
other party within 5 days Of knowlcdgc of such fact,
and the other parry may immediately turminato the
Agreement.
IN WITNESS WHEREOF,the pones have hereto executed
this Agrccmcnt.
AMERICAN MEDICAL RESFONSf WES1,
d/b/a NORTHERN CALIFORNIA TRAINING INSTITU 11
2007.06.20
By 15-1331 —07'00'
Lawson Smart,RN,MBA,MIC13
Executive Director,Academic Programs
Date:
APPROVED BY CITY MANAGER
P'AG.NP SPC21NG5 LrvrzE tlDEN,\oi'ONtlG;�A
By. rr LL APPROVED AS TO FORM!
Print
Print Title: fi�e L'k'e'F'
Date: 7/9�07 We:
A EST-
vGity Manager ty Clerk
5
Exhibit A
Student Intern Agreement and Release
Student is enrolled in a course of study at Experience program.
School designed to enable Student to become a
licensed/certnficd Emergency Medical Technician, The School shall require its students to complete a Criminal
Emergency Medical Technician-Paramedic or other similar Offenders Record information ("CORI") check By virtue
pic-Contractor health care provider. As part of the of this agreement, the School assures Contractor that it
curriculum, Student has enrolled in the Field Internship found no information that would, in accordance with the
Experience, which is offered through the School, with provisions of state EMS regulations, preclude the Student
Contractor's assistance. The field internship Experience from the duties of an EMS provider.
involves 1) Student's performing acquired pre-liospital
skills alongside Contractor's personnel, and, 2) "17le relationship of field internship Student and Contractor
accompanying and observing to Contractor's personnel is that of a student being provided an educational
providing emergency and non-emergency ambulance experience by Contractor and such activity shall in no way
transport,care and related services., be construed as creating any other relationship including an
employment relationship. The Student shall receive no
Student has asked to participate in Field Internship compensation from Contractor for activities during the
Experience Imowng that participation will require Student internship.
to accompany Contractor personnel in dangerous and
potentially lift-LhrcatcnSng situations. Student realizes that l Ile Student will comply in all material respects with all
Contractor could not, and would not, allow Student to applicable federal and state laws and regulations including,
accompany its personnel without his/her agreement to: (i) the Federal Aral-kickback statute. The Student
release the Contractor from anv and all claims for injury or acknowledges that School has made available to Student a
death which may result from Student's participation in the copy of its Compliance Program and Code of Conduct at
program; (it) assume the risk of dearh or injury associated School's web site, located of www amr.ncT. The Smdent
with the Field Internship Experience; (hi) agree to read, shall comply with any training requirements that may be
understand and follow Contractor's policies, procedures legally imposed upon School by any applicable regulatory
and guidelines; (iv) act in a professional and respectable authority.
manner at all limes;and(v) follow the instruction/direction
of Contractor personnel with respect to patient care, The Student represents and certifies that he/she has not
demeanor.safety,use of personal protective devices,etc. been convicted of any conduct identified on Attachment
"A The Student further represents and certifies That he/she
Student understands that he or she is exposing himself or is not ineligible to participate in Federal health cue
herself to certain risks inherent in the activities associated programs or in any other stale or federal government
with the Field internship Experience. Student hereby payment program, as provided on Attachment "A" or
represents that he or she AQRF.FS TO ASSUME TTW otherwise. The Student understands that if DHHS or OIG
RISKS 1NHMZJI NT IN THE ACTIVITY. These risks excludes he/she from participation in Fcderal health care
include, but are not limited to, being hurt or injured. (1)by programs, he/she must notify the School and Contractor
broken glass(or other scene hazards)including various cuts within 5 days ofk nowledge of such fact,and the Contractor
about the head, face. eyes, hands, legs, mid torso, (2) by may immediately terminate the Agreement.
uxposurc to tetanus or contagious diseases such as the
Hepatitis B virus and the Human Immunodeficiency Virus Sludcnt tali Fics that he/she is at (cast eighteen (18) years
C FIN"); (3) injury due to gurney lifts and or drops; (4) old and is an adult with full legal authority to execute This
injury from slip and fall type incidents; (5)various strains release.
and/or sprains to one and/or all muscle groups; (6) 6As
associated with emergency vehicle operation;and(7)risks B y ,Signing this Document You Acknowledge That You
at the scene of cmergcneles including assault and battery. Have Been Advised That There Are Risks Inherent in this
21 pe of Activity and Have Decided to Assume That Risk
In consideration of Contractor's agreement to provide the
and Release tie Company of and from All Liability. You
Field Internship Experience to Student, Student agree to Agree ta, Release the Company from Any Claims
release and forever discharge Contractor and its agents, Associated with the Event and That You, Not t1le
employees affiliates, parent corporation, successors and Company, Are Assuming Complete and Total
assigns of and from all claims, demands, suits, injuries or Responsibility for and Any and All Injuries, Damages or
damages of any hind arising in any way out of the Leases That You May Suffer as a Result of Participarfng
participation in this program in the Field Internship Experience Program.
Student Further agrees to: (i) follow Contractor's policies,
procedures and work rules; (in) follow Contractor's
instrucrion and direction with respect to pabcnt care,safety,
personal protection; and, abide by Contractor rules and
direction Student understands That failure to follow the
Contractor's direction may result, in Contractor's sole
discretion, in his/her expulsion Front the Field Internship
6
I agree to all terms set forth above. (3) Felony conviction relating to health
care fraud. Any individual or entity that has been
convicted for an olemo which occurred after August 21,
Dated: 1996, under Federal of State law, in connection with the
delivery of a health care item or service or with respect to
any act or omission in a health care program (other than
Signature of Student: those specifically described in paragraph (1)) operated by
or financed in whole or in purl by any Federal, State, or
local government agency, of a criminal offense consisting
Print Name: of a felony relating to fraud,theft embezzlement,breach of
fiduciary responsibility,m other financial misconduct.
Attachment"A" (4) Felony conviction relating to controlled
Overview of law regarding exclusion from substance. Any individual or entity that has been convicted
for an of"fensc which occurred after August 21, 1996,under
Medicare and State Health Care.Programs Federal or State law, of a criminal offence consisting of a
42 U.S.C. 1320a-7 folony relating to the unlawful manufacture, distribution,
prescription,or dispensing of a controlled substance.
(a) Mandatory exclusion. The Secretary shall
exclude the following individuals and entities From
participation in any Federal health care program(as delined (b) Permissive exclusion. The Secretary may
in section 1320a-7b(f)of this title): exclude individuals and entities from participation in any
Federal health care program. These Permissive Pxclusions
(1) Conviction of program-mlatcd crimes are for misdemeanors of the above (see 42 USC 1320a-
Any individual or entity that has been convicted of a 7(b)(1.15)) offenses plug other infractions that shall be
criminal offense related to the delivery of an item or survicc determined on an individual cuss-by-cast basis
under subchapter XVIII of this chapter or under any State
health care program.
(NOTE: the DII}IS and OIG list of excluded
2 Conviction relating to individuals/entities is available through the Internet at
O patient abuse. http://ww bb3 gov/oig), and an overview of the
Any individual or entity that has been wnvicted, under
redcral or State law, of a criminal ollenbe relating to exclusion regulations is attached hereto).
neglect or abuse of patients in connection with the delivery
of a health care item or service
7
Exhibit S
Fees, Compensation and Tuition
Neither party to this agreement shall receive any fees,compensation,or coition from the other parry for the provision of
any services parsaam to the terms hereof.
Exhibit C
Scope of Field Internship Experience
The Field Internship shall be conducted in accordance with the terms and requirements as mutually agreed to by the
parties.
9
Exhibit D
Overview of law regarding exclusion from
Medicare and State Health Care Programs
42 U.S.C. 1320a-7
(a) Mandatory exclusion. The Sccrctary shall exclude the following individuals and entities from participation in any
Federal health care program(as defined in section 1320a-7b(t)of this title):
(1) Conviction of program-related crimcs Any individual or entdv that has been convicted of a criminal offense
related to the delivery of an item or service under subchapter XVIII of this chapter or under any State health care program.
(2) Conviction relating to patient abuse. Any individual or cnuty that has been convicted,undur Federal or State
law,of a criminal offense rclating to neglect or abuse of-patients in connection with the delivery of a health care item or bcrvicc.
(3) Fclony conviction relating to health care fraud. Any individual or cmity that has been convicted for an
offense which occurred aller August 21, 1996.under Federal or State law,in connection with the delivery of a health care item or
service or with respect to any act or omission in a health care progrann(other than those specifically described in paragraph(1))
operated by or financed in whole or in part by any Federal.Stare,or local government agency,of a criminal offense consisting of
a Felony relating to fraud,theft,embezzlement,breach of fiduciary responsibility.or other financial misconduct,
(4) Felony conviction rclating to controlled substance. Any individual or cntiry that has been convicted for an
offense which occurred after August 21, 1996, under Fcdcral or State law,of a ctuninal offence consisting of a felony relating to
the unlawfid mmnufactute,distribution,prescription,or dispensing of a controlled substance.
(b) Permissive exclusion. The Secretary may exclude individuals and untitics from participation in any Federal health
care program. These Pennisbivu Exclusions an; for misdemeanors of the above (sue 42 USC 1320a-7(b)(1.15)) offenses pIw
other infractions that shall be deatni inud on an individual case-by-case basis.
(NOTE: the DITIIS and OTC list of excluded individuals/entities is available through the Internet at
http://www.hhs.�ov/aig),and an overview of the exclusion regulations is attached hereto).
10