Between NW INSTITUTE FOR HEALTHCARE TRAINING And, (FACILITY)

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1 NWIHCT Form #101C (revised: 06/2014) EXTERNSHIP AFFILIATION AGREEMENT PHARMACY TECHNICIAN TRAINING PROGRAM Between NW INSTITUTE FOR HEALTHCARE TRAINING And, (FACILITY) This is an Agreement between NORTHWEST INSTITUTE FOR HEALTHCARE TRAINING, (hereafter referred to as NW INSTITUTE) and (hereafter referred to as FACILITY), an Oregon profit/non-profit corporation doing business in, Oregon. NW Institute offers continuing education/degree programs to students in various health care professions. In order to provide practical, clinical training to students in its health care program, NW Institute wishes to place students in an Externship Pharmacy Technician Training program(s) at healthcare facilities in the State of Oregon. The FACILITY provides healthcare services and wishes to assist NW Institute in fulfilling its educational mission. THEREFORE the parties agree as follows: 1.0 Pharmacy Technician Training Externship Program 1.1 The parties shall cooperate to provide a learning experience to students of the PHARMACY EXTERNSHIP PROGRAM 1.2 The parties agree to participate in planning and evaluating meetings to implement and improve programs at the FACILITY. 2.0 Rights and Responsibilities of NW INSTITUTE NW Institute shall assign at least one (1) faculty member to act as liaison between NW Institute and FACILITY for planning and coordination of the program. NW Institute faculty members shall keep in touch with FACILITY for planning and coordination of the program. NW Institute will provide didactic instruction and class materials. NW Institute will ascertain that students participating in the program are in compliance with academic requirements. NW Institute will arrange orientation sessions to acquaint staff of the FACILITY with the program. Either party will arrange these orientations upon request. Mailing Address: PO BOX 757, Turner, Oregon Locations: 1860 Hawthorne Ave NE Salem, OR ~ SW Parkway Ave, Wilsonville, Oregon ~ fax ~ ~

2 NW Institute will instruct students and faculty to comply with administrative and ethics policies, regulations, standards, practices, and procedures of the FACILITY, particularly its policy concerning the confidentiality of patient information. NW Institute will instruct students and faculty to report promptly to the FACILITY Compliance Officer regarding any suspected billing or coding violations. NW Institute warrants that neither they nor any of their employees that are utilized at the FACILITY have been excluded from participation in the Medicare and/or Medicaid programs. NW Institute will notify each student of the following: 1. Student will provide his/her own uniform and transportation. 2. Student will report on time and as scheduled. 3. Student will conform to the standards of professional practice established by the FACILITY, NW Institute, and any applicable professionals or society while training at the FACILITY. 4. Student will be in compliance with applicable safety regulations prior to and during the externship experience. NW Institute will ascertain that students enrolled in the externship program shall be considered agents of NW Institute for purposes of the Oregon Tort Claims act, ORS to Up to the amount of its statutory tort claims limits, NW Institute agrees to insure or self-insure for claims against NW Institute, its employees and its agents resulting from their acts or omissions at FACILITY. NW Institute shall not be responsible for the acts or omissions of employees and agents of the FACILITY or for actions of students taken in conformity with the specific directions of employees of the agent or the FACILITY. NW Institute shall self-insure and/or maintain Workers Compensation Insurance for its employees and students for injuries or exposures arising out of participation in the clinical program at the FACILITY. Rights and Responsibilities of the FACILITY The FACILITY will provide an orientation to faculty and students participating in an externship program. The FACILITY will provide conference and classroom space, lounge, and locker space as requested, and as available in the facility. If appropriate, students may use the FACILITY S library and have access to such appropriate reference books and procedure manuals as are available. The FACILITY will provide access to medical records for educational use of students as necessary for students education subject to the FACILITY S rules regarding patients rights of privacy. The FACILITY may perform minor first aid treatment to students or faculty who become ill or injured while participating in these programs, and will submit to NW Institute a written explanation of the treatment. Students who may become injured while on the FACILITY S premises shall not be considered employees of the FACILITY and the FACILITY shall not assume any liability under any law relating to workers compensation benefits, disability benefits or any similar purposes for such injuries The FACILITY may not use students to replace staff members, and externship experiences must have academic value. Page 2 of 5

3 The FACILITY shall not consider students and faculty as employees of the FACILITY while they are participating in the programs that are the subject of this Agreement nor shall such students be eligible for any employee benefits provided by the FACILITY. The FACILITY may request a student whose performance or conduct is unsatisfactory or whose health status may have a detrimental effect on its staff, patients, or clients to withdraw from the externship program. This request must be in writing and be accompanied by written documentation and explanation as to the reason(s) for the withdrawal. The FACILITY is responsible for patient care and quality assurance. Discrimination Prohibited Northwest Institute will not tolerate racism, discrimination, harassment, exploitation or victimization of students, employees, non-employees or any person who are invitees of the Northwest Institute for any reason, including but not limited to race, color, ethnic background, national origin, religion, creed, age, citizenship, political affiliation, emotional, mental and/or physical challenge, sex, sexual orientation, marital status or any other protected class. Inquiries regarding non-discriminatory policies in employment may be directed to the designated company representative. Governing Law This Agreement shall be governed by and interpreted under the laws of the State of Oregon. Any litigation arising out of the Agreement shall be conducted in the courts of County, Oregon. Effectiveness, Continuance and Termination This Agreement shall be effective when executed by both parties. This Agreement shall continue in effect unless terminated by either party, with or without cause, upon at least sixty (60) days written notice at the addresses shown below. Notice of termination shall specify whether the party wishes to terminate the entire Agreement or only specific programs. Relationship of Parties It is understood and agreed that this Agreement is not intended and shall not be construed to create an employment relation between NW Institute s employees, agents or students and the FACILITY. NW Institute and the FACILITY are at all times acting and performing as independent contractors. Neither party shall receive any compensation pursuant to this Agreement, nor shall any student receive compensation or employee benefits from either party for services rendered while participating in an externship program at FACILITY. In the performance of its responsibilities hereunder, NW Institute and the FACILITY are and at all times shall be independent contractors. NW Institute and the FACILITY further agree to notify the other party if any governmental agency asserts that NW Institute or the FACILITY is not an independent contractor with respect to the other party; and to permit the other party to participate in any negotiations or proceedings involved in such matters. Neither NW Institute or the FACILITY shall have any power or authority to bind the other party or to assume or create any obligation or responsibility, express or implied, on behalf or in the name of the other party, except as expressly authorized by the other party. Page 3 of 5

4 Amendment This Agreement may be supplemented, amended or revised only in writing by signed agreement of both parties. HIPAA Regulations: One of the intents of this Agreement is to comply with the HIPAA regulations and that such regulations may evolve and change over time. The parties agree in advance to amend the Agreement as needed for compliance, so long as such amendments are commercially reasonable. Insurance and Indemnification To the extent permitted by Oregon law and by the Oregon Tort Claims Act (ORS through ) NW Institute agrees to defend, indemnify and hold harmless the FACILITY, its agents, servants and employees against any and all loss and expense, including attorneys fees and costs, by reason of liability imposed or claimed to be imposed by law upon the FACILITY for damages because of bodily injuries, including death at any time resulting there from, or on account of damage to property sustained by any person or persons arising out of or in consequences of the performance of the terms of this Agreement, providing such bodily injuries, death or damage to property arising or are claimed to have arisen out of negligence, or any other grounds of legal liability, including violation of any duty imposed by statute or ordinance or regulation, on the part of NW Institute, its employees or agents. The FACILITY shall promptly notify NW Institute in writing of any such claim or demand to indemnify and shall cooperate with NW Institute in a reasonable manner to facilitate the defense of such claim. The FACILITY shall not be called upon to assume the charges of the settlement or defense of any claim or suit brought or proceeding instituted against NW Institute, but the FACILITY shall have the right and shall be given the opportunity to associate with NW Institute in the defense and control of any claim, suit or proceeding relation to an occurrence where the claim, suit or proceeding involves, or appears reasonably likely to involve, the FACILITY, in which event NW Institute shall cooperate in the defense of such claim, suit, or proceeding. NW Institute will obtain and continue in force, during the terms of this Agreement all insurance, except such insurance as stipulated as being furnished by the FACILITY. NW Institute shall furnish, upon request, the FACILITY with a certificate of comprehensive general liability including blanket contract liability insurance coverage with minimum limits of $1,000,000 per student for protection of assigned students, certification of professional liability insurance coverage with minimum limits of $1,000,000 for protection of assigned students, and assurance or evidence that such coverage s are in force and will remain in force except that thirty (30) days written notice of cancellation, non-renewal or substantial change shall be given to the FACILITY. NW Institute shall furnish, upon request, the FACILITY with a certificate of comprehensive general liability insurance with minimum limits of $1,000,000 per occurrence and at least $3,000,000 in the aggregate and assurance or evidence that such coverage s are in force and will remain in force except that thirty (30) days written notice of cancellation, non-renewal or substantial change shall be given to the FACILITY. The FACILITY is not responsible for any claim by a student for any personal loss or personal injury resulting during the clinical rotation. It is agreed that neither any termination of this Agreement nor completion of the acts performed under this Agreement shall release NW Institute from the obligation to indemnify the FACILITY so long as the event upon which such claim or cause of action is predicated shall have occurred prior to the effective date of such termination or completion. Page 4 of 5

5 This Agreement signed by both parties is the parties final and entire Agreement and supersedes all prior and contemporaneous oral or written communications between the parties, their agents and/or representatives. There are not representations, promises, terms, conditions or obligations other than those contained herein. NORTHWEST INSTITUTE FOR HEALTHCARE TRAINING, INC P.O. BOX 757 Turner, OR NW Institute: (school official) Title: Signature: Date: Facility: (authorized official) Title: Signature: Date: Page 5 of 5

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