HOSPITAL TRNG AGT RE DIETETIC INT WITH HONORHEALTH.PDF

HOSPITAL TRAINING AFFILIATION AGREEMENT
This Affiliation Agreement ("Agreement") is entered into by and between Maricopa
County, acting by and for its Department of Public Health ("MCDPH"), whose principal office is
located at 4041 N. Central Ave., Ste. 1400, Phoenix, AZ 85012 and HonorHealth ("HOSPITAL")
(MCDPH and HOSPITAL may sometimes herein individually be referred to as a "Party" and
collectively as the "Parties"), an Arizona nonprofit corporation whose principal office is located
at 8125 N. Hayden Rd., Scottsdale, AZ 85258.
WHEREAS, MCDPH offers an accredited program in Dietetics (the "Program") and, as
part of the formal course of study desires to assign interns to HOSPITAL to obtain an on-site
learning experience;
WHEREAS, HOSPITAL provides comprehensive health care services at its facilities;
WHEREAS, HOSPITAL recognizes the need for on-site experiences in the training of
interns and desires to make available certain personnel, staff and facilities for a clinical
experience at HOSPITAL; and
WHEREAS, the Parties have agreed to cooperate in providing interns from the Program
with clinical learning experiences at HOSPITAL.
NOW THEREFORE, in consideration of the above recitals, the terms and conditions
hereinafter set forth, and other good and valuable consideration, the receipt and sufficiency of
which are hereby acknowledged, and for their mutual reliance, the Parties hereto agree as
follows:
I. RESPONSIBILITIES OF HOSPITAL:
A. General. HOSPITAL agrees to accept interns from MCDPH for the purposes of receiving
supervised training and experience. HOSPITAL will provide a planned, supervised program of
clinical experience designed in cooperation with MCDPH, and will provide such clinical
experience at its facilities.
B. Liaison/Staffing. HOSPITAL will designate a Program Liaison to serve as a liaison between
HOSPITAL and MCDPH and to coordinate the intern's on-site learning experience.
C. Intern Rotations. HOSPITAL shall provide interns with learning experiences as agreed to by
the Parties.
D. Supervision. HOSPITAL shall provide or arrange for its staff to provide such supervision of the
educational activities of each intern as is reasonable and appropriate to the circumstances and
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to the intern's level of training. HOSPITAL agrees that the interns are not to provide any care or
service to patients unless under the direct supervision of a practitioner designated by
HOSPITAL. While in the HOSPITAL's facilities, interns will have the status of trainees; are not to
replace HOSPITAL staff; and are not to render unsupervised patient care and/or services. All
services rendered by interns will have educational value and meet the goals of the Program.
E. Policies. At least two (2) weeks prior to the beginning of the rotation experience, HOSPITAL
will provide for the orientation of MCDPH's participating interns and MCDPH's on-site
employed faculty instructors, if any, (hereinafter referred to as "faculty instructor") as to the
HOSPITAL's rules, regulations, policies and procedures of HOSPITAL that relate to the activities
of the interns and/or faculty instructors under this Agreement, including, but not limited to, use
of HOSPITAL's electronic medical record. HOSPITAL reserves the right to either cancel or delay
the rotation if the orientation is not completed by the aforementioned deadline.
F. Facilities. HOSPITAL shall arrange for interns to have access to such facilities and resources as
are available and reasonably necessary for the activities of the interns under this Agreement
G. Evaluation. HOSPITAL staff will, upon request, assist MCDPH in the evaluation of the
performance of each intern at the termination of such intern's rotation and/or upon a schedule
mutually agreed to by the Parties, by completing evaluations or reports provided by MCDPH
and returning to MCDPH copies of such evaluations or reports in a timely fashion.
H. Intern Behavior/Termination. HOSPITAL may immediately remove from the premises and
retains the right to suspend or terminate any faculty instructor's or intern's participation at
HOSPITAL. HOSPITAL will promptly notice the appropriate office of the MCDPH if such an
action is required and the reasons for such action.
I. Patient Care. HOSPITAL reserves the right to make all decisions affecting patient care.
J. Emergency Health Care. HOSPITAL shall provide interns with such access to emergency care
as is provided to its employees during the time such interns are assigned to HOSPITAL. Intern
and/or faculty instructor shall notify MCDPH if a intern develops an illness or is involved in an
accident while at HOSPITAL. The Parties agree that the intern, and not MCDPH, shall bear the
cost of all emergency services rendered and MCDPH agrees to inform interns of such.
K. Insurance. HOSPITAL warrants and represents that at its sole cost and expense, shall insure
or self-insure its activities in connection with this Agreement and obtain, keep in force and
maintain a program of insurance as follows:
(I) Professional Medical and Hospital Liability self-insurance with limits of three
million dollars ($3,000,000) per occurrence;
(ii) General Liability Self-Insurance Program with a limit of three million dollars
($3,000,000) per occurrence;
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(iii) Workers' Compensation Insurance in a form and amount covering HOSPITAL's
full liability as required by law; and
(iv) Such other insurance in such amounts which from time to time may be
reasonably required by the mutual consent of the Parties against other insurable
risks relating to performance.
L. Patient Privacy Training and Oversight. HOSPITAL shall provide appropriate training to interns
on rotation regarding patient privacy and confidentiality. Such training shall satisfy the
requirements of all applicable Federal and state laws and regulations, including, but not limited
to, the Health Insurance Portability and Accountability Act of 1996 and related regulations.
Solely for the purpose of defining the interns' role in relation to the use and disclosure of
HOSPITAL's protected health information, such interns are defined as members of the
HOSPITAL's workforce, as that term is defined by 45 CFR 160.103, when engaged in activities
pursuant to this Agreement. However, such interns are not and shall not be considered to be
employees of HOSPITAL.
M. Educational Records. To the extent HOSPITAL generates or maintains educational records
related to the participating intern, HOSPITAL agrees to comply with the Family Educational
Rights and Privacy Act ("FERPA"), to the same extent as such laws and regulations apply to
MCDPH, and shall limit access to only those employees or agents with a need to know. For the
purposes of this Agreement, pursuant to FERPA, MCDPH hereby designates HOSPITAL as a
MCDPH official with a legitimate educational interest in the educational records of the
participating intern(s) to the extent that access to MCDPH's records is required by HOSPITAL to
carry out the Program.
II. RESPONSIBILITIES OF MCDPH:
A. General. MCDPH shall retain full responsibility for the planning, implementation, and
execution of the Program, including programming, administration, accreditation, curriculum,
content, grading and requirements for matriculation, promotion and graduation.
B. Liaison. MCDPH shall designate an individual to serve as Program Designee. The Program
Designee shall be the liaison between MCDPH and HOSPITAL to coordinate the academic
experience of the interns, and to assist, as necessary, in operating an effective on-site learning
experience. The Program Designee shall work with HOSPITAL to coordinate intern activities and
training. The Program Designee shall communicate regularly with HOSPITAL either via written
communication or telephone at mutually agreed upon intervals. MCDPH shall notify HOSPITAL
in writing of any change or proposed change in the individual designated to serve as the
Program Designee.
C. Assignment of Interns. MCDPH shall, upon mutual agreement of the Parties, provide to
HOSPITAL at least thirty (30) days prior to the beginning of the rotation:
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(1) the number and names of interns;
(ii) the schedule of assignments, number of on-site hours, and the date range of the on-
site learning experience;
(iii) a letter confirming the good standing of the intern and copies of all required
documentation;
(iv) the name of the Program Designee and contact information; and
(v) a summary of the intern's education and experience and field work, if requested by
HOSPITAL.
D. Qualification of Interns and Faculty Instructors. MCDPH shall refer to HOSPITAL only
those interns and faculty instructors who meet all qualifications for the clinical program.
MCDPH shall designate for participation in the rotation only those faculty instructors and
interns who have successfully completed the requirements necessary for their participation in
the rotation and are in good standing with the MCDPH, If a faculty instructor's or intern's good
standing status changes while assigned to HOSPITAL, MCDPH agrees to notify HOSPITAL and to
remove the faculty instructor and/or intern from participation in the rotation at HOSPITAL,
effective immediately.
E. Health and Safety Requirements. Before placement, MCDPH shall provide safety training to
all interns and faculty instructors to include OSHA regulations and associated work place
practices. MCDPH shall instruct interns and faculty instructors that they are required to provide
proof to HOSPITAL that they meet the health standard requirements applicable to hospital
employees, which shall include the following:
(i) Proof of immunity by documentation of one of the following for each disease:
Measles a) documentation of two live doses of vaccine (given at least 28 days
apart) and given on or after the intern's first birthday
b) lab titer indicating immunity
c) birth before 1957
Rubella a) documentation of one live dose given on or after their first birthday;
b) lab titer indicating immunity
c) birth before 1957
Mumps a) documentation of one live dose given on or after their first birthday
b) lab titer indicating immunity
c) documentation of physician-diagnosed case of disease, if born before
1957
Varicella a) verbal history of disease
b) lab test indicating immunity
c) 2 doses of varicella vaccine
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Hepatitis B a) immunizations
b) titers OR
c) signed waiver/declination
(ii) Tuberculosis (TB) screening:
2-step TB testing via Mantoux method, given 7-10 days apart (only one needs to be
given if they have documentation of negative TB skin test within last year); if positive
reaction (equal to or greater than lOmm INDURATION), chest x-ray is to be performed,
with no evidence of active disease in order to begin learning experiences; if history of
positive reaction, no TB test is given but should have no current signs and symptoms of
TB, with documentation of negative chest x-ray within six months. If a faculty instructor
or a intern currently has signs and symptoms of TB, a current and negative chest x-ray
will be required prior to beginning the assigned rotation, internship, or externship
(iii) Drug Screen:
Drug panel 154 urine drug screen must be completed with negative results within thirty
(30) days prior to the-intern's and/or a faculty instructor's start date (unless the faculty
instructor is continuously employed by MCDPH and/or intern is continuously enrolled at
MCDPH) with interpretation by a medical review officer as necessary. In the event the
drug screen is not conducted at HOSPITAL, the screening and cut-off levels of the drug
screen must match those of HOSPITAL. MCDPH must rescreen any faculty instructor or
intern upon a leave of absence return or for cause.
(vi) Fingerprint Clearance Card:
All interns and on-site faculty instructors who are 18 years or older assigned to
HOSPITAL are required to obtain a current fingerprint clearance card from the Arizona
Department of Public Safety (DPS). This fingerprint clearance card must encompass
state and federal checks for criminal and sex offender offenses. If while a intern and/or
a faculty instructor is participating in a rotation at HOSPITAL s/he commits a criminal
offense, MCDPH will notify HOSPITAL of the offense.
(vii) Current Level C CPR card or Basic Life Support (BLS) for healthcare providers
certification.
(viii) Flu shot:
All interns and on-site faculty instructors are required to demonstrate receipt of an
influenza vaccine once per year. If the vaccine is declined, the intern and/or faculty
instructor must wear a mask in all patient-care areas while at HOSPITAL at all times.
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MCDPH must submit documentation to HOSPITAL verifying completion of the required health
and safety requirements prior to on-site arrival. This documentation must be in a format
acceptable to HOSPITAL and must be received at least thirty (30) days prior to the intern's
and/or the faculty instructor's first day at HOSPITAL. Any exception to this provision must be
approved by HOSPITAL before placement of the intern or faculty instructor. HOSPITAL retains
the right to remove any intern or faculty instructor who does not meet or maintain the
standards set forth herein. MCDPH shall maintain copies of submitted documentation,
including but not limited to the results of all testing, for a minimum of seven (7) years after the
termination of the rotation. HOSPITAL reserves the right to ask MCDPH for proof of testing at
any time.
Interns and/or faculty instructors who do not comply with the requirements of this Section II(D)
will not be eligible to utilize HOSPITAL for rotations, internships, or externships. HOSPITAL
reserves the right to terminate this Agreement in the event of falsification or misrepresentation
of the requirements set forth in this Section 11(0).
F. Policies. MCDPH, its employees, agents and faculty instructors, shall comply and shall require
all interns to comply with the bylaws, rules and regulations, policies and procedures of
HOSPITAL.
G. Confidentiality of Patient Information. MCDPH, its employees, agents and faculty instructors
shall maintain and shall require all interns and faculty instructors to maintain the confidentiality
of all patient records and data and obtain appropriate authorization prior to any disclosure of
such records and data. MCDPH shall provide all interns with basic Health Insurance Portability
and Accountability Act ("HIPAA") training in order to prepare them for their professional
careers in healthcare. MCDPH agrees that all of its interns and on-site faculty instructors are
considered part of the workforce of HOSPITAL while performing treatment and healthcare
operations as defined by 45 CFR 160.103, when engaged in activities pursuant to this
Agreement. However, such interns and faculty instructors are not and shall not be considered
to be employees of HOSPITAL for any purpose. Interns and faculty instructors shall be subject to
the HIPAA related policies and procedures of HOSPITAL.
H. Insurance. MCDPH warrants and represents that, at its sole cost and expense, it shall insure
or self-insure its activities in connection with this Agreement and obtain, keep in force and
maintain a program of insurance as follows:
(i) Professional Medical and Hospital Liability insurance coverage or program of self-
insurance with limits of one million dollars ($1,000,000) per occurrence and three
million dollars ($3,000,000) annual aggregate. If such insurance is written on a
claims-made form, it shall continue for five (5) years following termination or
expiration of this Agreement. The insurance shall have a retroactive date prior to or
coinciding with the effective date of this Agreement. In the event that a claims-
made policy is canceled or non-renewed, the MCDPH shall obtain extended
reporting (tail) coverage for the remainder of the five (5)-year period (said tail
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coverage shall be in amounts and type equivalent to the occurrence based coverage
provided herein).;
(ii) Comprehensive General Liability Insurance (contractual liability included) of not less
than one million dollars ($1,000,000) per occurrence and three million dollars
($3,000,000) annual aggregate. If such insurance is written on a claims-made form,
it shall continue for three years following termination or expiration of this
Agreement. The insurance shall have a retroactive date prior to or coinciding with
the effective date of this Agreement.; and
(iii) Workers' Compensation Insurance in a form and amount covering MCDPHS's full
liability as required by law; and
(iv) Such other insurance in such amounts which from time to time may be reasonably
required by the mutual consent of the Parties against other insurable risks relating
to performance.
I. Dismissal of Interns. MCDPH agrees to allow HOSPITAL to dismiss interns and/or faculty
instructors from the clinical experience at HOSPITAL for lack of professional behavior or poor
academic performance if, in the sole discretion of HOSPITAL, such dismissal is warranted.
MCDPH may terminate a intern's and/or faculty instructor's participation when, in its sole
discretion, it determines that further participation by the intern and/or faculty instructor would
no longer be appropriate. MCDPH will notify HOSPITAL if such action is required.
J. Accommodations. MCDPH agrees to make all arrangements for consultation and assistance
with/for its interns regarding tuition, housing, transportation, etc.
K. MCDPH and Program Accreditation. MCDPH agrees to maintain any relevant MCDPH and
Program accreditation. If accreditation is revoked or the Program and/or MCDPH is placed on
probationary status, MCDPH agrees to notify HOSPITAL immediately. HOSPITAL reserves the
right to ask MCDPH for proof of accreditation at any time and to immediately cancel or
terminate learning and/or supervisory experiences and/or this Agreement (without completion
of the on-site learning experience) based upon MCDPH's or the Program's accreditation status.
L. Work Statement. To complete program graduation requirements, the interns will meet the
47 Core Competencies and 10 Community Competencies for the Supervised Practice
Components of entry level dietitians as listed in the Commission on Accreditation for Dietetic
Education Accreditation Handbook, © 2002, pages 32-35. All interns will receive a copy of these
competencies.
III. GENERAL PROVISIONS
A. Patient Care. The Parties agree that HOSPITAL and its employees, and staff have independent
discretion to make professional judgments relating to the delivery of health care services and
that MCDPH shall neither have nor exercise control or direction the manner in which HOSPITAL
and its employees and staff deliver health care services to patients.
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B. Term and Termination. The term of this Agreement shall be from September 1, 2015 through
June 30, 2020. Thereafter, this Agreement may be renewed upon mutual agreement of the
Parties. The Parties may terminate this Agreement for any reason upon sixty (60) days written
notice. Should this Agreement be terminated prior to its expiration date, interns and/or faculty
instructors assigned to HOSPITAL shall be permitted to complete their rotations pursuant to the
terms and conditions of this Agreement.
C. Status of the Parties. The Parties agree that no intern or faculty instructor participating in
the Program shall be considered an employee, agent, contractor, or representative of HOSPITAL
for any purpose including, but not limited to, workers compensation, employee benefits, salary,
and professional liability. The Parties further agree that no employee or agent of HOSPITAL shall
be considered an employee, agent, contractor, or representative of MCDPH for any purpose
including, but not limited to, workers compensation, employee benefits, salary, and
professional liability. The Parties expressly understand and agree that this Agreement is not
intended and shall not be construed to create the relationship of agent, servant, employee,
partnership, joint venture or association among the Parties, but is, rather an agreement by and
among independent Parties. The Parties further understand that no compensation or
reimbursement will be due from one party to the other by virtue of entering this Agreement.
D. Indemnification.
(i) MCDPH shall defend, indemnify and hold HOSPITAL harmless from and against any
and all liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages arising out of the performance of this Agreement, but only to the extent
such liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages are caused by or result from the negligent acts or omissions or willful
malfeasance of the MCDPH, its officers, employed faculty, employees, interns, or
faculty Instructors (if applicable).
(ii) HOSPITAL shall defend, indemnify and hold the MCDPH harmless from and against
any and all liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages arising out of the performance of this Agreement, but only to the extent
such liability, loss, expense, reasonable attorneys' fees, or claims for injury or
damages are caused by or result from the negligent acts or omissions or willful
malfeasance of HOSPITAL, its officers, staff, or employees.
(iii) In the event that any claim, demand, action or suit occurs because of any action or
inaction related to this Agreement and both MCDPH and HOSPITAL are involved,
then MCDPH and HOSPITAL agree to cooperate and reasonably assist each other in
the investigation, evaluation, resolution and/or defense of same by their respective
attorneys, employees, agents, or representatives.
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E. Discrimination. MCDPH and HOSPITAL agree not to discriminate in the selection or
acceptance of any intern pursuant to this Agreement because of race, color, national origin,
religion, sex, sexual orientation, mental or physical disability, age, veteran's status, medical
condition, ancestry, marital status, or citizenship. Both parties hereto agree to comply with all
state and Federal laws, rules, regulations, and executive orders as to equal employment
opportunity, non-discrimination and affirmative action including Arizona Executive Order No.
2009-09.
F. Business Associate. The parties agree that in the context of the arrangement contemplated in
this Agreement, MCDPH does not stand in a business associate relationship with HOSPITAL, as
the term "business associate" is currently defined under HIPAA. No business associate
relationship is established pursuant to this Agreement because the MCDPH, and the interns and
the faculty instructors perform no actions or activities on behalf of HOSPITAL or its patients in
performance of the clinical training. Solely for the purpose of defining the intern's and/or
faculty instructor's role in relation to the use and disclosure of HOSPITAL's protected health
information, interns and on-site faculty instructors will be part of HOSPITAL's "workforce" for
purposes of compliance with the HIPAA when engaged as trainees working under the direct
control of the HOSPITAL's clinical instructors. However, the interns and faculty instructors are
not and shall not be considered to be employees of the HOSPITAL.
G. Force Majeure. Either Party shall be excused from any delay or failure in performance
hereunder caused by reason of any occurrence or contingency beyond its reasonable control,
including, but not limited to, acts of God, acts of war, fire, insurrection, labor disputes, riots,
earthquakes, or other acts of nature. The obligations and rights of the Party so excused shall be
extended on a day-to-day basis for the time period equal to the period of such excusable
interruption. In the event the interruption of a Party's performance continues for a period in
excess of thirty (30) days, the other Party shall have the right to terminate this Agreement upon
ten (10) days' prior written notice to the other Party.
H. Assignment. Neither Party shall assign their rights, duties, or obligations under this
Agreement, either in whole or in part, without the prior written consent of the other Party.
I. Severability. If any provision of this Agreement is held to be illegal, invalid, or unenforceable
under present or future laws effective during the term hereof, such provision shall be fully
severable. This Agreement shall be construed and enforced as if such illegal, invalid, or
unenforceable provision had never been a part of the Agreement, and the remaining provisions
shall remain in full force and effect unaffected by such severance, provided that the severed
provision(s) are not material to the overall purpose and operation of this Agreement.
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J. Waiver. Waiver by either Party of any breach of any provision of this Agreement or warranty
or representation herein set forth shall not be construed as a waiver of any subsequent breach
of the same or any other provision. The failure to exercise any right hereunder shall not
operate as a waiver of such right. All rights and remedies provided for herein are cumulative.
K. Amendment. This Agreement may be amended or modified at any time by mutual written
consent of the authorized representatives of both Parties. MCDPH and HOSPITAL agree to
amend this Agreement to the extent amendment is required by an applicable regulatory
authority and the amendment does not materially affect the provisions of this Agreement.
L Governing Law. This Agreement shall be governed in all respects by the laws of the State of
Arizona, and is subject to the provisions of A.R.S. § 38-511.
M. Notices. All notices required under this Agreement shall be deemed to have been fully given
when made in writing and delivered by: (i) personal delivery; (ii) deposit in the United States
mail, postage prepaid, certified mail, return receipt requested; or (iii) overnight courier service,
and addressed as follows:
HOSPITAL:
Student Program Specialist
HonorHealth
Workforce Development Department
8125 N. Hayden Rd.
Scottsdale, AZ 85258
MCDPH:
Strategic Planning & Operations Supervisor
Maricopa County Department of Public Health
4041 N. Central Ave., Ste. 1400
Phoenix, AZ 85012
N. Entire Agreement. This Agreement contains all the terms and conditions agreed upon by the
Parties regarding the subject matter of this Agreement and supersede any prior agreements,
oral or written, and all other communications between the Parties relating to such subject
matter.
0. Use of Name. Neither Party shall use the name of the other without the prior written
approval from an authorized representative of that Party.
P. Signature Authorization. Any individual executing this Agreement on behalf of the HOSPITAL
represents and warrants to MCDPH that they are duly authorized to execute this Agreement on
behalf of the HOSPITAL, and that upon their signature this Agreement shall be binding upon the
HOSPITAL.
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Q. Effect of Laws. If any legislation, regulation or government policy are passed or adopted or if
these laws, regulations or policies are interpreted in a manner that would materially affect
either Party's participation in or implementation of this Agreement as written, the Party raising
such concern shall provide notice of such law, regulation, policy or provision to the other Party,
and the Parties agree to negotiate in good faith within thirty (30) days to modify the terms of
this Agreement to comply with the applicable law, regulation or policy. If the Parties cannot
agree upon the necessary modification, either Party may terminate this Agreement on thirty
(30) days' advance written notice.
R. No Exclusion. MCDPH represents and warrants that MCDPH and its representatives and
interns and faculty instructors are not: (1) currently excluded, debarred, or disqualified by any
federal governmental agency or program or otherwise ineligible from receiving federal
contracts or assistance; (2) present on the exclusion database of the Office of the Inspector
General or the Government Services Administration; or (3) convicted of a criminal offense
related to the provision of health care or under investigation for any of the above
circumstances.
S. Compliance Requirements for A.R.S. § 41-4401, Government Procurement, E-Verify
Requirement.
(i) HOSPITAL warrants compliance with all federal immigration laws and regulations
relating to employees and warrants its compliance with A.R.S. § 23-214, Subsection
A (that subsection reads: "After December 31, 2007, every employer, after hiring an
employee, shall verify the employment eligibility of the employee through the E-
Verify program and shall keep a record of the verification for the duration of the
employee's employment or at least three years, whichever is longer").
(ii) A breach of warranty regarding compliance with immigration laws and regulations
shall be deemed a material breach of this Agreement and the HOSPITAL may be
subject to penalties up to and including termination of the Agreement.
(iii) Failure to comply with a State audit process to randomly verify the employment
records of contractors and subcontractors shall be deemed a material breach of this
Agreement and the HOSPITAL may be subject to penalties up to and including
termination of the Agreement.
(iv) The State of Arizona retains the legal right to inspect the papers of any employee
who works on this Agreement to ensure that the contractor or subcontractor is
complying with the warranty under Paragraph 12.A.
(v) For questions about E-Verify the HOSPITAL should visit the following web site:
http://www.uscis.gov/portal/site/uscis.
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IN WITNESS WHEREOF, the Parties hereto have signed this Agreement effective as of
the date set forth above.
MARICOPA COUNTY
Acting by and for its Department of Public HonorHealth
Health
By: By:
Chairman, Date
Maricopa County Board of Supervisors Name:
Title:
Attest:
Clerk of the Board Date
10/i 9/Zoic
Director, MCDPH ' Date
Approved as to Form Date
Deputy County Attorney
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