Healthcare Food Bank Agreement

HEALTHCARE FOOD BANK AGREEMENT

Parties and Effective Date

This Agreement is entered into between Healthcare Provider: and Food Bank: .

Effective Date:

Contact and Notice Information

Purpose and Scope

Purpose: The parties will cooperate to provide non-food-medical support and supplemental nutrition resources to patients and households identified by the Healthcare Provider. Services to be provided by the Food Bank may include distribution of shelf-stable items, fresh produce, nutrition education materials, and referral assistance.

Service Location(s):

Distribution Modality: On-site distribution at Healthcare Provider facility Off-site collection / referral to Food Bank location Home delivery by Food Bank

Responsibilities of the Healthcare Provider

Referral Process: Healthcare Provider shall identify eligible patients and households in accordance with Provider’s policies and will obtain any required patient authorizations prior to sharing Protected Health Information (PHI). Provider shall use Provider-approved referral forms and shall not disclose PHI to the Food Bank without a valid written patient authorization where required by law.

Screening and Consent: Provider will inform patients of program benefits, risks, and alternative resources and obtain patient consent for participation in the food assistance program when necessary. Provider shall document consent in the patient's medical record.

On-site Support: If on-site distribution is selected, Provider will provide a designated space that meets basic access and safety needs and coordinate scheduling with the Food Bank.

Responsibilities of the Food Bank

Food Safety and Storage: Food Bank shall store, handle, and distribute food in accordance with applicable local and state public health regulations and industry best practices. Food Bank is responsible for temperature control, labeling, and ensuring items are safe for distribution.

Personnel and Training: Food Bank shall ensure personnel conducting distribution are trained on food safety, confidentiality expectations, and non-discrimination policies. Food Bank representatives shall present identification upon request.

Recordkeeping & Reporting: Food Bank will maintain records of distributions and provide aggregate reports to Provider at the following frequency: . Reports shall include the number of households served, units distributed, and any incidents affecting safety or compliance.

Confidentiality and Protected Health Information

HIPAA Compliance: Each party represents that it will comply with all applicable laws concerning privacy and security of PHI. Food Bank shall not use or disclose PHI for any purpose other than the performance of its obligations under this Agreement and shall implement appropriate safeguards to prevent unauthorized use or disclosure.

Use of PHI: Food Bank will only accept PHI if accompanied by a documented, written authorization signed by the patient or as otherwise permitted by law. Please indicate whether Food Bank will receive limited PHI for care coordination: Yes No

Breach Notification: In the event of an actual or suspected unauthorized disclosure of PHI, the receiving party shall notify the disclosing party promptly and cooperate in mitigation and notification efforts consistent with applicable law.

Liability, Insurance, and Indemnification

Indemnification: Each party agrees to indemnify, defend, and hold harmless the other party and its officers, directors, employees and agents from and against any third-party claims, liabilities, losses, damages, costs or expenses arising out of the indemnifying party’s negligence, willful misconduct, or breach of this Agreement.

Insurance: Food Bank shall maintain insurance coverage appropriate for distribution activities, including general liability and, if applicable, automobile and volunteer liability insurance. Provider may request certificates of insurance upon reasonable notice.

Term, Amendment, and Termination

Term: This Agreement shall commence on the Effective Date and continue for a period of unless earlier terminated in accordance with this Agreement.

Termination: Either party may terminate this Agreement for convenience upon thirty (30) days’ prior written notice. Either party may terminate immediately for material breach that remains uncured for a period of ten (10) days following written notice.

Amendment: Any amendment to this Agreement must be in writing and signed by authorized representatives of both parties.

Compliance and Non-Discrimination

Compliance: Parties shall comply with all applicable federal, state, and local laws and regulations in the performance of this Agreement.

Non-Discrimination: Food Bank shall provide services without discrimination on the basis of race, color, religion, sex, national origin, disability, age, sexual orientation, gender identity, or immigration status.

Reporting of Incidents and Food Recalls

Incident Reporting: Food Bank shall promptly notify Provider of any incident, illness report, or safety event reasonably believed to be related to distributed food. In the event of a product recall, Food Bank shall cooperate with Provider to identify affected recipients and facilitate notification as appropriate.

Special Terms and Additional Provisions

Acknowledgements

By signing below, each party represents and warrants that it has the full authority to enter into this Agreement, that it will perform its obligations in accordance with applicable law, and that the individuals executing this Agreement are authorized representatives.

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