Sound Consulting Nurse PLLC th Avenue SW, Suite E-1 Burien, WA F soundconsultingnurse.
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1 SOUND CONSULTNG NURSE PLLC AGREEMENT Sound Consulting Nurse PLLC This agreement is between: Sound Consulting Nurse PLLC th Avenue Sw, E1 Phone: FAX: And PROSPECTIVE CLIENT : PROSPECTIVE CLIENT, enter into an agreement to outline the specific responsibilities of the parties and to allow for SCN to provide the Telephone Nurse Consultation service to PROSPECTIVE CLIENT as specified in the following agreement. Twisp, WA
2 DESCRIPTION OF SERVICES: The program is operational during the following hours: Monday to Friday: 4:30pm 9:00am Saturday/Sunday/Holidays: 9:00am to 9:00am (24 hours) During the hours the SCN is answering the lines, information and advice is provided to the consumer (patient) by a Registered Nurse with special training in nursing and medical telpehone advice procedures. The nurse follows a standardized procedure and protocol for medical advice based on the nature of the Patient s chief complaint. Sound Consulting Nurse s mission is to provide after-hours call service for providers distinct from a conventional answering service in that a client s medical needs are triaged by qualified Registered Nurses before the provider is ever contacted. Our goal is to provide patients with the highest quality of telephone triage service and thereby enable a safe and cost-effective disposition of the patient. SCN will provide telephone access and services in accordance with existing policies and procedures to PROSPECTIVE CLIENT during the regularly scheduled hours of operation. SCN will fax a copy of the telephone encounter if requested by the PROSPECTIVE CLIENT. Twisp, WA
3 BILLING: SCN will provide a billing statement to PROSPECTIVE CLIENT specifying the number of calls made to the telephone consulting line by PROSPECTIVE CLIENT patients. PROSPECTIVE CLIENT will pay: - $ per call billed at the end of the month and due by the 20 th of the following month. PROSPECTIVE CLIENT will provide the name of a contact person for program interface with SCN. - PROSPECTIVE CLIENT will reimburse SCN for AT&T Language Line or other lanquage line calls pertinent to the PROSPECTIVE CLIENT. - PROSPECTIVE CLIENT will reimburse SCN for all costs associated with requesting a separate phone line for calls pertinent to the PROSPECTIVE CLIENT. - PROSPECTIVE CLIENT will respond to a call or page from the Sound Consulting Nurse within 30 minutes. If there is no response within 30 minutes, the Sound Consulting Nurse will attempt to call a provider in another call group in the same specialty. LIABILITY INSURANCE: SCN agrees to provide liability coverage of 1 million to 3 million dollars for any errors or omissions and all other standard liability for the Telephone Consultant Services rendered through SCN. PROSPECTIVE CLIENT agrees to provide evidence of standard liability coverage for any errors or omissions and all other standard liability for services rendered. Twisp, WA
4 INDEMNIFICATION: SCN agrees to indemnify and hold harmless PROSPECTIVE CLIENT for actions, claims, or proceedings arising out of the negligent acts or omissions of SCN s officers, employees, staff and agents which occur during their performance of their responsibilities under the terms of this agreement. PROSPECTIVE CLIENT agrees to indemnify and hold harmless SCN for actions, claims, or proceedings arising out of the negligent acts or omissions of PROSPECTIVE CLIENT s officers, employees, staff and agents which occur during their performance of their responsibilities under the terms of this agreement. Effective Date This agreement shall become effective on: and shall continue for one year or until terminated by either party upon 60 days written notice to the other party. The agreement shall be reviewed and renewed on an annual basis. Twisp, WA
5 Signature: Date: (Sound Consulting Nurse PLLC) Signature Client: Date: (Client) BILLING OFFICE: Twisp, WA : Desmond Rabinowitz MD Cell: Nurse Owner: Sandy Varon RN Cell: Nurse Owner: Elaine Murphy RN, C-TNP Cell: Nurse Owner: Carol Skotheim RN, CN Cell: Twisp, WA
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