COLLABORATION AGREEMENT

This Collaboration Agreement (the “Agreement”) is entered into between XXX, located in [address] XXXX (the “Business” “the Facility”) and XXXX, whose address is XXX(the “Collaborating Physician” XXXX) on [Date].

RECITALS:

WHEREAS, XXX is a healthcare business duly organized and existing under the laws of the State of Mississippi, and operates a primary care clinic and spa (the “Facility”). The Facility provides a range of healthcare services, including IV hydration, and injections, to its patients;

WHEREAS,XXX is a licensed physician who desires to collaborate with XXXX and XXX Brown FNP-BC in the provision of IV hydration, and injections services to patients at the Facility;

WHEREAS, the parties wish to enter into a collaboration agreement to set forth the terms and conditions of their collaboration, and to ensure compliance with all applicable laws and regulations governing the practice of medicine in the State of Mississippi;

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties agree as follows:

  1. Scope of Collaboration:
    • The Facility seeks to engage the services of the Collaborating Physician, Dr. Laura Purdy MD, as the Medical Director to provide medical oversight and support for the Nurse Practitioner on staff.
    • Laura Purdy MD will be responsible for reviewing and approving the patient charts maintained by the Nurse Practitioner to ensure that they meet the highest standards of medical care. In the event of an emergency, Dr. Laura Purdy MD will be available to provide medical assistance and advice to the Nurse Practitioner, but will not be required to see patients unless deemed necessary by the Nurse Practitioner or the Business.
    • Laura Purdy MD will provide expert guidance and support to the Nurse Practitioner in their delivery of medical care to patients, and ensure that all medical protocols and procedures are followed in accordance with the highest professional standards.
  1. Business Arrangement
    • Business Relationship:
      • The parties to this Agreement intend to establish a mutually beneficial business relationship that is in compliance with all applicable federal and state laws and regulations.
      • The parties agree that Collaborating Physician will provide medical oversight and support for NaturesCareplan Spa. The parties agree that Collaborating Physician will offer medical expertise and guidance to support the operations of NaturesCareplan Spa. Collaborating Physician will provide necessary supervision and consultation, ensuring the delivery of high-quality medical care in accordance with applicable laws and regulations. It is understood that the role of the Collaborating Physician is not that of a primary care physician, but rather to provide medical oversight within their specific field of expertise.
    • Billing and Collections:
      • NaturesCareplan Spa shall be responsible for billing and collecting all fees for services provided by Collaborating Physician.
      • NaturesCareplan Spa shall be responsible for collecting payment directly from patients for services provided by Collaborating Physician. Payment for services shall be made by patients on an out-of-pocket basis.
    • Referrals:
      • Collaborating Physician may also refer patients to other healthcare providers for specialty care services as appropriate. The parties agree to work together in good faith to ensure that patients receive appropriate care.
    • Records:
      • Collaborating Physician shall maintain accurate and complete patient medical records in accordance with all applicable state and federal laws and regulations.
      • NaturesCareplan Spa shall have the right to review and sign off on all patient charts and medical orders issued by Collaborating Physician.
      • NaturesCareplan Spa shall also be responsible for maintaining accurate records of all controlled substances prescribed by Collaborating Physician, and shall ensure that such prescriptions are issued in compliance with state and federal laws and regulations.
    • Term:
      • The term of this Business Arrangement shall commence on the Effective Date and shall continue until terminated by either party upon thirty (30) days’ written notice to the other party.
    • Termination:
      • Either party may terminate this Business Arrangement at any time upon thirty (30) days’ written notice to the other party.
      • Upon termination, Collaborating Physician shall return all patient medical records to NaturesCareplan Spa and shall not retain any copies thereof.
  1. The duties of the Collaborating Physician will include the following:
    • The duties of the Collaborating Physician will include the following:
      • Management of Patient Health/Illness Status
        • Obtain an appropriate comprehensive or problem-focused health history from the patient
        • Perform an appropriate comprehensive or problem-focused physical examination
        • Differentiate between normal, variations of normal and abnormal findings
        • Provide health promotion, disease prevention services, anticipatory guidance and counseling to promote health
        • Order, analyze and interpret data, including history, presenting symptoms, physical findings, and diagnostic information to develop appropriate differential diagnoses
        • Diagnose and manage acute and chronic conditions while attending to the patient’s response to the illness experience
        • Prioritize health problems and intervene appropriately including initiation of effective emergency care
        • Employ appropriate diagnostic and therapeutic interventions and regimens including but not limited pharmacological, behavioral and other non-pharmacological treatment modalities with attention to safety, cost, invasiveness, simplicity, acceptability, adherence, and efficacy
        • Formulate an action plan based on scientific rationale, evidence-based standards of care and practice guidelines
        • Integrate knowledge or pharmacokinetic processes and factors that alter pharmacokinetics in pharmacologic management decisions
        • Provide guidance and counseling regarding management of the health/illness conditions
        • Communicate the patient’s health status using appropriate terminology, format and technology
        • Initiate appropriate and timely consultation and/or referral when the problem exceeds the Facility’s scope of practice.
        • Collaboratively assess, plan, implement, and evaluate care with other health care professionals using approaches that recognize each one’s expertise to meet the comprehensive needs of the patient(s)
        • Consider the patient’s needs when termination of the Facility ‘s service and provide a safe transition to another care provider.
        • Monitoring Quality of Health Care Practice
        • Develop and implement a quality assurance/quality improvement plan as evidenced by
        • Review a sample of random charts picked by the Collaborating Physician that represent 10% or 20 charts, whichever is less, of patients seen by [Name]. Patients that [Name] and the Collaborating Physician have consulted on during the month will count as one chart review
        • Maintain a log of charts reviewed which includes the identifier for the patient’s charts, reviewer’s name, and dates of review
        • Meet face to face with [Name] once per quarter for the purpose of quality assurance. An agenda will be created along with the charts reviewed, and signatures from both [Name] and the Collaborating Physician will be maintained
        • Act ethically to meet the needs of patients
        • Use an evidence-based approach to patient management that critically evaluates and applies research findings pertinent to patient care management and outcomes
        • Evaluate the patient’s response to the health care provided and the effectiveness of the care
        • Use the outcomes of care to revise care delivery strategies and improve the quality of care.
      • Controlled Substances
        • The Facility will follow standards of care related to ordering controlled substances for patients.
        • Patients receiving controlled substances for chronic use will have a signed “Controlled Substance” Contract in the patient’s chart.
        • The Facility will follow the Practitioner’s Manual: An Informational Outline of the Controlled Substances Act published by the United States Department of Justice, Drug Enforcement Administration (DEA), and Office of Diversion Control when prescribing controlled substances.
        • The Facility will only be allowed to prescribe Schedule II-V medications per Mississippi Board of Nursing regulations.
      • Emergency Plan
        • In the event of a patient emergency that requires a higher level of care than can be provided in the specific clinic setting, the Facility will: o Assist with stabilization of the patient’s condition. o Request assistance through 911. o Transport the patient by ambulance to the nearest emergency facility. o Notify the collaborating physician as to the event.
  1. Chart Review Process
    • Collaborating Physician shall conduct periodic chart reviews of the Facility’s patient charts to ensure compliance with all applicable state and federal laws and regulations.
    • Collaborating Physician shall review and sign off on all patient charts and medical orders issued by the Facility.
    • Collaborating Physician shall provide written feedback to the Facility regarding the quality and completeness of the patient charts and medical orders issued by the Facility.
    • The Facility shall make all patient charts and medical orders available to Collaborating Physician for review and sign-off.
    • Collaborating Physician shall review all medical orders issued by the Facility within 48 hours of issuance.
    • Collaborating Physician shall document all chart reviews and sign-offs in writing, and such documentation shall be maintained in a separate file.
    • Collaborating Physician shall conduct periodic performance evaluations of the Facility, which shall include a review of the quality and completeness of the patient charts and medical orders issued by the Facility.
    • Collaborating Physician shall provide written feedback to the Facility regarding any deficiencies identified during the chart review process.
    • The Facility shall promptly address any deficiencies identified during the chart review process, and shall take appropriate corrective action.
    • Collaborating Physician shall ensure that all patient charts and medical orders are maintained in accordance with all applicable state and federal laws and regulations.
    • Both parties shall be responsible for maintaining the confidentiality and security of all patient charts and medical orders.
    • Collaborating Physician shall ensure that all patient charts and medical orders are stored in a secure location, and that access to such charts and orders is limited to authorized personnel only.
    • The Facility shall cooperate fully with Collaborating Physician in the chart review process, and shall promptly provide any information or documents requested by Collaborating Physician in connection with such reviews.
    • Collaborating Physician shall be available to consult with the Facility regarding any questions or concerns arising during the chart review process.
    • The chart review process set forth in this Clause 4 shall be subject to the provisions of the Confidentiality and HIPAA Compliance Clause.

 

  1. Compensation
    • The Collaborating Physician will be compensated at a rate of $[X] per hour for her services. This shall be paid by [insert name of the third party]
    • The payment will be made on a monthly basis and will be due on the first of each month.
  1. Monthly Performance Review Meeting:
    • Collaborating Physician and a representative from the Facility shall participate in a monthly performance review meeting via Zoom or any other video calls to discuss the services provided by the Facility during the previous month.
    • The purpose of the monthly performance review meeting is to ensure that the Facility is providing high-quality IV hydration, and injections services to patients, and to identify any areas for improvement.
    • The parties agree to work together in good faith to address any issues or concerns that arise during the monthly performance review meeting.
    • Facility shall provide a report to the Collaborating Physician prior to the meeting outlining the services provided during the previous month, including the number of patient visits, any referrals to other healthcare providers, and any other relevant information.
    • The monthly performance review meeting shall be scheduled in advance, and both parties agree to make every effort to attend the meeting as scheduled.
    • If either party is unable to attend the scheduled meeting, they shall notify the other party as soon as possible and make arrangements to reschedule the meeting at a mutually convenient time.
    • This monthly performance review meeting shall be in addition to any other meetings or consultations that the parties may have during the term of this Agreement.

 

  1. Power of Attorney
    • The Facility hereby grants Dr. Prudy full power and authority to act on its behalf in all matters related to the provision of healthcare services to patients, including but not limited to the following:
      • To make decisions regarding the medical treatment and care of patients in accordance with applicable laws and regulations.
      • To sign, execute and deliver all necessary and appropriate documents, including consent forms, medical orders, prescriptions, and any other documents related to the provision of healthcare services to patients.
      • To access and review patient medical records as necessary to provide healthcare services and make treatment decisions.
      • To consult with other healthcare professionals, including other physicians, nurses, and therapists, as necessary to provide healthcare services to patients.
      • To make referrals to other healthcare providers as necessary to ensure that patients receive appropriate care.
      • To bill and collect fees for services rendered in accordance with applicable laws and regulations.
      • To take any other actions necessary or appropriate to provide healthcare services to patients.
    • This Power of Attorney shall be effective immediately upon execution and shall remain in effect until revoked in writing by the Facility. The Facility acknowledges that it is fully responsible for any actions taken by Dr. Prudy under this Power of Attorney and agrees to indemnify and hold harmless Dr. Prudy from any and all claims, damages, or liabilities arising out of or in connection with such actions.
  1. Governing Law
    • This agreement shall be governed by and construed in accordance with the laws of the State of Mississippi.
    • In the event of any dispute arising out of or in connection with this agreement, the parties agree to first attempt to resolve the dispute through good faith negotiations.
    • If the dispute cannot be resolved through negotiations, the parties agree to submit the dispute to mediation in accordance with the rules of the American Arbitration Association.
    • If the dispute cannot be resolved through mediation, either party may initiate arbitration proceedings in accordance with the rules of the American Arbitration Association.
    • The arbitration shall take place in the State of Mississippi, and the arbitrator’s decision shall be final and binding on both parties. The prevailing party in any such dispute shall be entitled to recover its reasonable attorneys’ fees and costs from the other party. The provisions of this clause shall survive termination of this agreement.
  1. Entire Agreement
  • This agreement constitutes the entire agreement between the parties and supersedes all prior agreements and understandings, whether written or oral, relating to the subject matter of this agreement.
  1. Counterparts
  • This agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

IN WITNESS WHEREOF, the parties have executed this agreement as of the date first above written:

XXXX                                  XXX

By: _______________________________            By: ________________________________

Title: _____________________________             Title: _______________________________

Date: _____________________________            Date: ______________________________

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