AGREEMENT FOR VISITING RESIDENT PARTICIPATION IN CLINICAL EDUCATION By and Between VANDERBLT UNIVERSITY And

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1 AGREEMENT FOR VISITING RESIDENT PARTICIPATION IN CLINICAL EDUCATION By and Between VANDERBLT UNIVERSITY And WHEREAS, this Agreement ( Agreement ) is entered into on this day of by and between TheVanderbilt University, by and through its Medical Center, ( Vanderbilt ) and (name of Institution) ( Institution ) for the purpose of providing a short term clinical training experience to Institution s resident physician(s) ( Visiting Resident ); and WHEREAS, both parties recognize that they share mutual goals of optimum patient care, excellent graduate medical education and development of better systems of health care delivery and seek to implement these goals through residency education training, in accordance with the terms and conditions set forth herein; NOW THEREFORE, in consideration of the foregoing and of the mutual promises and covenants contained herein, the receipt and sufficiency of which are hereby acknowledged, the parties do hereby agree as follows: 1. Contact information for notice and other purposes: a. Vanderbilt Vanderbilt University Medical Center Office of Graduate Medical Education 209 Light Hall Nashville, TN Att: Patricia Craft, Admin. Director, GME b. Institution 2. Departments involved: a. Vanderbilt Department - Program Director- Resident Supervisor - b. Institution Department Program Director - 3. Period of Agreement/Term: FROM: TO: 4. Visiting Resident Participating in Short Term Rotation: Graduate level of Visiting Resident: PGY Name of Visiting Resident: 5. Rotation Name and Content: Insert Goals and Objectives if relevant 1

2 6. Program Requirements for Visiting Resident: a. In order to be eligible to participate in a Rotation, Visiting Resident must meet the requirements and timely submit all documentation listed on the Vanderbilt website at namely: i. Visiting Resident application; ii. NPI number; iii. Reference letter from Institution s Program Director indicating good standing in the program; iv. Background check consent; and v. Immunization and testing; vi. Copy of valid ECFMG certificate and Visa if applicable. b. Institution shall require Visiting Resident to comply with all applicable Vanderbilt policies, procedures, rules, and regulations, including patient care policies. Visiting Resident may be removed from the training experience at Vanderbilt s discretion for failure to follow same. Notwithstanding anything herein to the contrary, removal may be without notice to Institution where patient care is endangered. c. Vanderbilt shall retain responsibility for the care of its patients and provide clinical supervision for Visiting Resident. d. If requested by Institution, Vanderbilt shall provide an evaluation of Visiting Resident s Rotation, as agreed upon by the parties. e. Where Resident is not licensed in TN or not currently practicing under the exemption for licensure, Vanderbilt will apply to the Board of Medical Examiners for an exemption in accordance with TN law. 7. Insurance: a. Institution shall maintain in full force and effect during the term of this Agreement general and professional liability insurance covering Institution against all claims arising out of or related to the performance of services by the Visiting Resident providers performing clinical functions in connection with this Agreement. Such insurance shall be in coverage amounts of not less than $1 million per incident and $3 million annual aggregate. b. Vanderbilt shall maintain in full force and effect during the term of this Agreement general and professional liability insurance covering Vanderbilt, its employees and agents ( insureds ) against all claims arising out of or related to the performance of services by such insureds in connection with this Agreement. Such insurance shall be in coverage amounts of not less than $1 million per incident and $3 million annual aggregate. c. Coverage provided under sub-section a and b above shall be for a minimum of five (5) years following expiration or termination of this Agreement and shall provide for a retroactive date no later than the inception date of this Agreement. d. Each party shall provide the other with proof of the foregoing insurance coverage upon request. Each party shall notify the other of cancellation or significant reduction of insurance coverage. 2

3 8. Indemnification: e. Institution shall provide or cause Visiting Resident to maintain health insurance covering the term of participation in Rotation at Vanderbilt. f. Each party shall maintain worker s compensation and employer liability insurance covering all of its employees who are engaged in any work under this Agreement. Visiting Resident shall be covered by Institution s worker s compensation coverage. g. Vanderbilt may choose to provide the coverage stated above through a program of selfinsurance. f. Institution will indemnify, defend and hold harmless Vanderbilt, its trustees, officers, employees, and physicians from and against any and all liability and claims of liability arising out of or in any way connected with the negligent acts or omissions of Visiting Residents while providing services at Vanderbilt. g. The indemnification obligations of this section shall survive termination of this Agreement. 9. Financial Arrangements: h. Visiting Resident shall not be an employee of Vanderbilt for any purpose i. Institution shall pay the costs of the Visiting Resident s salary, benefits, and other direct costs of medical education of Visiting Resident while on Rotation at Vanderbilt. 10. Confidentiality of Medical Information: Both parties shall maintain the confidentiality of patient medical information as required by law. The parties understand that the Visiting Resident will be required to comply with Vanderbilt s policies and procedures relating to the protection of confidential patient medical information with respect to all services provided at Vanderbilt s facility during the term of this Agreement. 11. Corporate Compliance: Each party affirms to the other that it is not excluded from participation, and is not otherwise ineligible to participate in a Federal health care program as defined in 42 USC 1320a-7b(f) or in any other state or federal government payment program. In the event that a party is excluded from participation, or becomes otherwise ineligible to participate in any such program, during the term of this Agreement, that party will notify the other party in writing, and upon the occurrence of any such event, whether or not appropriate notice is given, this Agreement shall be terminated 12. Governing Law: The laws of the State of Tennessee shall govern this Agreement. 13. Amendment: Any amendment to this Agreement shall be in writing and duly executed by appropriate representatives of each of the parties. 3

4 On Behalf of Vanderbilt Program Director Donald W. Brady, M.D. Associate Dean, Graduate Medical Education On Behalf of Institution 4

5 5

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