Attach 01 - Third Party Clinical Agree Template.docx

Provisions for Agreements between Contractor and Clinical Rotation Provider: See PWS Section 4.0 requirement. Contractor may include the below provisions using this template or its own; however, all the below provisions below must be agreed to verbatim unless otherwise agreed to by the Government. Insert CLINICAL ROTATION PROVIDER AND CONTRACTOR names as applicable.

AGREEMENT FROM CLINICAL ROTATION PROVIDER [INSERT] REGARDING NAVAL SPECIAL WARFARE COMMAND (NSW) STUDENTS IN RELATION TO CONTRACT NUMBER [INSERT] WITH CONTRACTOR [INSERT] BACKGROUND: NSW, as a government Department of Defense (DOD) entity, has an interest in maintaining the emergency medical capabilities of NSW Special Operations Combat Medic and Special Operations Tactical Medic Program (SOTM) personnel though skills sustainment and training. NSW has a contract with CONTRACTOR [INSERT] for training and paramedic certification course of instruction. The CONTRACTOR [INSERT] as part of its contract duties is facilitating clinical rotation for NSW SOTM personnel at CLINICAL ROTATION PROVIDER [INSERT].

CLINICAL ROTATION PROVIDER [INSERT] is physically located at [INSERT], email [INSERT] and phone number [INSERT].

In relation to NSW personnel participation in the clinical rotation, CLINICAL ROTATION PROVIDER [INSERT] UNDERSTANDS and AGREES:

1. To retain responsibility for the care of all clients/patients.

2. To administratively and professionally supervise the NSW trainees in their duties performed.

3. To provide clinical supervision of NSW trainees while participating under this Agreement.

4. To provide emergency care to NSW trainees and NSW members in case of accident or illness while engaged in clinical learning experiences. All health care (emergency or otherwise) a NSW trainee or NSW member receives will be at the expense of the individual involved or of the Federal Government, as appropriate.

5. To be responsible for informing CLINICAL ROTATION PROVIDER [INSERT] personnel regarding the rights and privileges of NSW trainees.

6. To identify a point of contact to liaison with CONTRACTOR [INSERT] and NSW regarding NSW’S participation in the clinical rotation.

7. Via CONTRACTOR [INSERT] to assist NSW in collaborative assessment and appropriate documentation for each trainee's performance and skill progression.

8. Via CONTRACTOR [INSERT], provide qualified personnel to supervise, instruct, and mentor trainees in coordination with either NSW SOTM Programmatic goals or pre-defined sustainment goals for NSW personnel as agreed upon prior to starting rotations.

9. That any and all data and information (including, but not limited to, financial information, sales information, and all other information) related to NSW business operations that is made known unless otherwise required by law, hereinafter referred to as Proprietary Information, is and shall remain the property of NSW. CLINICAL ROTATION PROVIDER [INSERT] agrees to the extent permitted by law, to keep the Proprietary Information confidential, not to disclose such information to any third party and to use the information only for the purpose referenced in this Agreement and not for his/her own purposes. Upon NSW’s request, the CLINICAL ROTATION PROVIDER [INSERT], via CONTRACTOR [INSERT], shall either promptly return in the format and on the media request by NSW or erase or destroy all Proprietary Information in its possession. Written certification as to destruction of Proprietary Information shall be provided by the CLINICAL ROTATION PROVIDER [INSERT], via CONTRACTOR [INSERT].

a. On 21 September 2001, the Department of Defense designated Headquarters United States Special Operations Command (USSOCOM) a sensitive unit, as defined by Title 10 United States Code (USC) Section 130b (IO USC 130b). In keeping with this designation, unclassified information related to USSOCOM military technology acquisitions managed by USSOCOM or any of its component commands, including NSW, will be designated Controlled Unclassified Information (CUI). As such, CLINICAL ROTATION PROVIDER [INSERT] hereby unequivocally agrees that they shall not release to anyone outside the CLINICAL ROTATION PROVIDER [INSERT] any unclassified information, regardless of medium (e.g., film, tape, document, CLINICAL ROTATION PROVIDER [INSERT] external websites, newspaper, magazine, journal, corporate annual report, etc.), pertaining to NSW related to their participation in the clinical rotation, unless NSW, via CONTRACTOR [INSERT], has given prior written approval.

b. Request for approval shall identify the specific information to be released, the medium to be used, and the purpose for the release. Via CONTRACTOR [INSERT], the CLINICAL ROTATION PROVIDER [INSERT] shall submit the request at least 45-days before the propose date for release for approval. No release of any restricted information shall be made without specific written authorization by the NSW, via CONTRACTOR [INSERT].

c. CLINICAL ROTATION PROVIDER [INSERT] further understands that Title 18 USC Section 701 specifically prohibits the use of the NSW emblem or logo in any medium (e.g., corporate website, marketing brochure, newspaper, magazine, etc.) unless authorized in writing by the Department of the Navy Office of Naval Research, Patent and Trademark Counsel.

10. All NSW trainees participating in clinical rotations will do so under the authority of official orders issued by the USN. NSW trainees will be assigned in a temporary additional duty status. The USN will provide all pay and allowances for all NSW trainees performing duties at the CLINICAL ROTATION PROVIDER [INSERT]. Accordingly, while performing such duties, NSW trainees are employees of the USN acting within the scope of their employment under Federal law. Consequently, the provisions of the Federal Tort Claims Act (Title 28, United States Code, Sections 1356(b), 2671-2680), including its defense and immunities, will apply to allegations of negligence or wrongful acts or omissions by NSW trainees while acting within the scope of their duties. Furthermore, it is understood by the CLINICAL ROTATION PROVIDER [INSERT] that the U.S. Government may only protect the liability of NSW trainees, and that the U.S. Government may, in its representation of NSW trainees, assert any defense available under Federal law.

a. Claims against the USN made under the Federal Tort Claims Act should be filed with the following office:

Address:

Office of the Judge Advocate General Tort Claims Unit Norfolk 9620 Maryland Ave. Suite 20S Norfolk, VA 23511-2949

Toll Free: (888) 897-8217

COMM: (757) 440-631 S

DSN: 564-3310

Fax: (866) 782-7297 Fax DSN: 564-3337 E-mail: NorfolkClaims@navy.mil

b. Any notifications of an actual or potential claim or suit against the CLINICAL ROTATION PROVIDER [INSERT] that names NSW trainees as parties or potential defendants will be reported to NSW via CONTRACTOR [INSERT] by the CLINICAL ROTATION PROVIDER [INSERT] as soon as possible. The CLINICAL ROTATION PROVIDER [INSERT] will make the report to:

Force Judge Advocate General Naval Special Warfare Command 2000 Trident Way, Bldg 624 San Diego, CA 92155

COMM: (619) 537-1119

c. To the extent legally permissible, the CLINICAL ROTATION PROVIDER [INSERT] agrees to cooperate fully with the U.S. Government in the investigation of any complaint, to include making available for review any medical records, medical material, radiographs, slides, tissue, and witness statements, and the names of all other defendants.

d. The USN will cooperate with the CLINICAL ROTATION PROVIDER [INSERT] in the investigation and defense of such complaints and assist in the removal of the action to an appropriate U.S. District Court with a view toward substituting the U.S. Government as a defendant in lieu of NSW trainees.

11. Billing. The parties understand and agree that the CLINICAL ROTATION PROVIDER [INSERT] will generate bills for medical services, if applicable, rendered by its employees. All proceeds from these bills shall become the exclusive property of the CLINICAL ROTATION PROVIDER [INSERT]. NSW shall have no right or claim to such proceeds. If applicable, the City may generate bills for all professional services rendered by its employees, including for services on which the trainees assisted or received instruction, and all monies received shall be the exclusive property of the CLINICAL ROTATION PROVIDER [INSERT]. NSW shall have no right or claim to such proceeds. The CLINICAL ROTATION PROVIDER [INSERT] cannot bill TRICARE for the professional services rendered by NSW personnel.

12. Payments. NSW personnel are prohibited from receiving any form of monetary payments, compensation, gratuities, or other contributions from the CLINICAL ROTATION PROVIDER [INSERT]. This prohibition includes any entity that may be under contract with the CLINICAL ROTATION PROVIDER [INSERT]. The parties understand and agree that the training of NSW personnel at the CLINICAL ROTATION PROVIDER [INSERT] is not intended to cause, nor will it result in, displacement of any CLINICAL ROTATION PROVIDER [INSERT] employee or impair existing contracts for their services.

13. CLINICAL ROTATION PROVIDER [INSERT] shall include both NSW and CONTRACTOR [INSERT] on any correspondence and ensure both parties have copies of all correspondence generated under this Agreement.

CLINICAL ROTATION PROVIDER SIGNATURE

AUTHORIZED REPRESENTATIVE POSITION TITLE AND NAME

DATE

CONTRACTOR SIGNATURE

AUTHORIZED REPRESENTATIVE POSITION TITLE AND NAME

DATE