Healthcare Support Contract

HEALTHCARE SUPPORT CONTRACT

This Healthcare Support Contract (the Agreement) is entered into between Client Name: and Provider/Agency Name: Effective Date:

1. Client Information

2. Insurance and Billing

3. Scope of Services

Provider shall furnish Healthcare Support Services to Client as described below. Services include, but are not limited to, the following selected items and any additional services agreed in writing:

4. Term, Termination and Amendment

Term: This Agreement commences on Start Date: and continues until End Date: unless earlier terminated in accordance with this Section.

Either party may terminate this Agreement for convenience upon providing Written Notice to the other party at least days prior to the effective termination date. Provider may terminate immediately for reasons including but not limited to threat to staff safety, nonpayment, or material breach by Client.

Amendments to this Agreement must be in writing and signed by authorized representatives of both parties.

5. Fees, Billing and Payment

Client agrees to pay Provider the fees described below. Hourly Rate: $ Per Visit Fee: $

Late payment may result in suspension or termination of services. Client is responsible for any collection costs, including reasonable attorney fees, incurred by Provider to collect overdue payments.

6. Medical History and Client Responsibilities

Client shall promptly inform Provider of any changes in medical condition, medications, living arrangements, or emergency contacts. Client shall ensure the environment is safe for service provision and provide any necessary supplies unless otherwise agreed.

7. Provider Obligations, Staffing and Background Checks

Provider will ensure that personnel assigned to perform services are appropriately licensed, trained, and have passed required background checks. Provider shall maintain supervision, credentialing records, and provide replacement staff if regular personnel are unavailable. Provider is responsible for verifying competency for any delegated clinical tasks in accordance with applicable law.

Provider may utilize qualified subcontractors; however, Provider retains responsibility for acts and omissions of subcontractors to the same extent as for Provider's employees.

8. Confidentiality and Privacy

Provider shall maintain the confidentiality of Client health information in accordance with applicable privacy laws. Provider may use and disclose health information only as necessary to provide services, bill for services, or as otherwise authorized by law or by Client in writing. Client acknowledges receipt of Provider's privacy practices and consents to permitted disclosures for treatment, payment and operations.

9. Emergency Medical Treatment and Incident Reporting

In the event of a medical emergency, Provider will attempt to contact Emergency Contact provided and Client's primary care provider. If immediate treatment is required and Client is incapacitated or the emergency contact cannot be reached, Provider is authorized to arrange emergency medical care at Client's expense.

Provider shall document and report all incidents, injuries, or near-misses to Client or Client's representative in writing within a reasonable time and shall cooperate with any subsequent investigation.

10. Liability, Indemnification and Insurance

Provider shall maintain professional liability and general liability insurance as required by applicable law. To the extent permitted by law, Provider's liability for claims arising out of performance under this Agreement shall be limited to direct damages and shall exclude punitive and consequential damages. Client agrees to indemnify and hold harmless Provider, its employees and agents from claims arising from Client's negligence, failure to disclose medical information, or breach of this Agreement.

11. Governing Law and Dispute Resolution

This Agreement shall be governed by the laws of the state in which services are principally provided, without regard to conflict of laws principles. The parties agree to attempt good faith negotiation to resolve disputes. If unresolved, disputes shall be resolved by binding arbitration, unless otherwise prohibited by law.

12. Miscellaneous

Entire Agreement: This Agreement constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements and understandings. Severability: If any provision is held invalid, the remainder of the Agreement shall remain effective. Assignment: Neither party may assign this Agreement without the prior written consent of the other, except that Provider may assign to an affiliate or successor in interest.

13. Authorization and Expiration

Client hereby authorizes Provider to provide the services selected herein and to access necessary medical records for care coordination. This authorization expires on:

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