PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP (2).DOCX

PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP
AFFILIATION AGREEMENT
This Agreement is entered into by and between PRIORITY NUTRITION CARE LLC, located at 14 Holly Street.,
Hingham, MA 02043, which provides a program of supervised practice in the area of Nutrition and Dietetics
(“PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP”) and Maricopa County administered by the
Human Services Department, Education Division - Head Start program located in Phoenix, AZ (“THE
AFFILIATED INSTITUTION”). PRIORITY NUTRITION CARE and Maricopa County Head Start hereby agree as
follows:
1. PURPOSE.
The purpose of this Agreement is to allow DIETETIC INTERNS from PRIORITY NUTRITION CARE
DISTANCE DIETETIC INTERNSHIP to use the facilities of an Affiliated Institution to integrate theory
learned in their didactic programs with practice and to develop abilities and skills through planned
and supervised clinical (supervised practice) experience. It is agreed by the parties that a program of
supervised experiential education (the "Program") shall be conducted for DIETETIC INTERNS of
PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP under the following terms and
conditions:
2. AFFILIATED INSTITUTION OBLIGATIONS:
2.1 Provide a liaison person who shall be responsible for coordinating the clinical/non-clinical
experience with designated representatives of PRIORITY NUTRITION CARE DISTANCE
DIETETIC INTERNSHIP.
2.2 Retain responsibility for information given to its DIETETIC INTERNS.
2.3 Use reasonable efforts to provide appropriate facilities for storage of personal belongings,
areas for changing clothing and, when requested, conference room space if available. THE
AFFILIATED INSTITUTION shall not be responsible for the safety or loss of such personal
belongings.
2.4 Allow DIETETIC INTERNS access to its library facilities and use, but not removal of, library
materials, if applicable. Allow DIETETIC INTERNS use of cafeteria facilities at their own
expense.
2.5 Arrange to provide emergency health care for DIETETIC INTERNS at the closest emergency
room and with the Intern's consent, notify the Program of any care given to the Intern.
Costs incurred shall be responsibility of the DIETETIC INTERN.
2.6 Consult with PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP in the event a
DIETETIC INTERN's behavior or skills indicate a problem. THE AFFILIATED INSTITUTION
reserves the right to require that a DIETETIC INTERN be terminated from assignment at THE
AFFILIATED INSTITUTION. Moreover, THE AFFILIATED INSTITUTION reserves the right to
require any DIETETIC INTERN to immediately leave THE AFFILIATED INSTITUTION’s premises
if THE AFFILIATED INSTITUTION determines in its discretion that the continued presence of
such DIETETIC INTERN on THE AFFILIATED INSTITUTION’s premises threatens patients,
clients, staff, visitors or the policies of THE AFFILIATED INSTITUTION.
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2.7 Reserve the right to limit the number of DIETETIC INTERNS accepted for experience in a
specific area. The number of DIETETIC INTERNS who can be accepted for the Program for
any given period of time shall be determined by THE AFFILIATED INSTITUTION and will be
dependent upon its philosophy, available space, DIETETIC INTERN or client population, and
qualified staff. The experience period will be the amount of time agreed upon by PRIORITY
NUTRITION CARE DISTANCE DIETETIC INTERNSHIP and THE AFFILIATED INSTITUTION.
2.8 Provide an orientation to the DIETETIC INTERN(S) assigned to THE AFFILIATED INSTITUTION,
including instruction on the relevant policies and procedures of THE AFFILIATED
INSTITUTION. THE AFFILIATED INSTITUTION further agrees to provide the same information,
training, and protection to the DIETETIC INTERNS in matters of health and safety as it
provides to its employees in compliance with the standards set by the Occupational Safety
and Health Administration (OSHA) and applicable law.
2.9 THE AFFILIATED INSTITUTION shall not offer full-time employment to any DIETETIC INTERN
currently enrolled at PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP pursuant to
this Agreement if such employment would materially interfere with or terminate the
DIETETIC INTERN’s enrollment at PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP
unless consented to by PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP in
writing, which such consent shall not be unreasonably withheld.
2.10 Give the DIETETIC INTERNS appropriate and timely evaluation and feedback concerning their
achievement, and provide PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP with
timely reports of such evaluations as requested.
2.11 Limit use of the name of PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP in
promotional or publicity materials to brochures and publications that list affiliations of THE
AFFILIATED INSTITUTION when describing THE AFFILIATED INSTITUTION’s programs, and to
obtain prior written consent for all other written references to PRIORITY NUTRITION CARE
DISTANCE DIETETIC INTERNSHIP in promotional or publicity materials.
2.12 Preceptors who are Registered Dietitians shall submit proof of registration by the
Commission on Dietetic Registration and a copy of their Curriculum Vitae and continuing
education activities for the most recent 12 month period to PRIORITY NUTRITION CARE
DISTANCE DIETETIC INTERNSHIP. All other preceptors shall submit copies of relevant
professional credentials and curriculum vitae.
3. PRIORITY NUTRITION CARE’S OBLIGATIONS. PRIORITY NUTRITION CARE DISTANCE DIETETIC
INTERNSHIP agrees to:
3.1 Be fully approved/licensed or accredited and, upon request, to submit proof to THE
AFFILIATED INSTITUTION of said accreditation, and to maintain this accreditation throughout
the term of the Agreement.
3.2 Assign DIETETIC INTERNS to THE AFFILIATED INSTITUTION who have been adequately
prepared for a rotation in the assigned area. PRIORITY NUTRITION CARE DISTANCE DIETETIC
INTERNSHIP shall inform THE AFFILIATED INSTITUTION of the level of training the DIETETIC
INTERNS have received prior to this placement.
3.3 Furnish THE AFFILIATED INSTITUTION with current information about its curriculum and
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education goals and objectives prior to the start of each DIETETIC INTERN's clinical
experience.
3.4 Assign DIETETIC INTERNS to THE AFFILIATED INSTITUTION who have been instructed to act in
a professional manner and to conform to the rules and regulations of THE AFFILIATED
INSTITUTION, and who have agreed to do so.
3.5 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP shall require its DIETETIC
INTERNS to maintain liability insurance in an amount of at least $1,000,000 per occurrence
and at least $3,000,000 aggregate.
3.6 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP warrants and represents that
each DIETETIC INTERN conforms to the health status standards set forth by THE AFFILIATED
INSTITUTION, including all vaccinations required by THE AFFILIATED INSTITUTION.
3.7 Notify the liaison person at THE AFFILIATED INSTITUTION of any known communicable
disease (e.g., chicken pox) contracted by a DIETETIC INTERN or faculty member up to three
(3) weeks after the clinical rotation has ended.
3.8 Inform DIETETIC INTERNS of THE AFFILIATED INSTITUTION’s requirement that they maintain
as confidential all records and other data to which they may have access and not to copy or
remove privileged records or information from the premises.
3.9 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP may withdraw any DIETETIC
INTERN from the Program whose progress, achievement or adjustment does not appear to
justify his/her continuing with the Program. Wherever possible, such withdrawal shall be
planned cooperatively by PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP and
THE AFFILIATED INSTITUTION.
3.10 Inform DIETETIC INTERNS and faculty of THE AFFILIATED INSTITUTION’s policy that DIETETIC
INTERNS wear identification badges as requested by THE AFFILIATED INSTITUTION. To
instruct the DIETETIC INTERNS in regard to proper dress code expected of them by THE
AFFILIATED INSTITUTION.
3.11 Limit use of the name of THE AFFILIATED INSTITUTION to brochures and publications that list
affiliations of PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP when describing
PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP’s programs, and to obtain prior
written consent for all other written references to THE AFFILIATED INSTITUTION.
3.12 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP will designate a Program
Coordinator to work with the Affiliation Coordinator at THE AFFILIATED INSTITUTION in
coordinating the academic aspects of the DIETETIC INTERN's education with the experience.
3.13 While at THE AFFILIATED INSTITUTION, all DIETETIC INTERNS of PRIORITY NUTRITION CARE
DISTANCE DIETETIC INTERNSHIP shall at all times abide by the policies and procedures
established and communicated by THE AFFILIATED INSTITUTION.
3.14 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP warrants and represents that
each DIETETIC INTERN has current health insurance coverage, which shall remain in effect
throughout their assignment to THE AFFILIATED INSTITUTION.
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3.15 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP represents and covenants that it
will comply with all applicable federal and state statutes and regulations, and THE
AFFILIATED INSTITUTION’s commitment to conduct its business in compliance with THE
AFFILIATED INSTITUTION’s ethical standards and business policies, as communicated to
PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP by THE AFFILIATED INSTITUTION.
3.16 PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP performs a criminal background
check of each DIETETIC INTERN assigned to THE AFFILIATED INSTITUTION and reviews the
results of such background check prior the start of the DIETETIC INTERN’s rotation.
4. JOINT OBLIGATIONS. Both PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP and THE
AFFILIATED INSTITUTION agree as follows:
4.1 This Agreement is not intended, and shall not be construed, to create the relationship of
agent, servant, employee, partnership, association or joint venture between PRIORITY
NUTRITION CARE DISTANCE DIETETIC INTERNSHIP, THE AFFILIATED INSTITUTION and the
DIETETIC INTERN, but is rather an Agreement by, and between, independent contractors.
PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP and its DIETETIC INTERNS shall
not be entitled to reimbursement of any kind or nature for any services provided to
employees of THE AFFILIATED INSTITUTION.
4.2 The Affiliated Facility agrees to indemnify and hold harmless Priority Nutrition Care LLC, the
Board, its officers, agents and employees for any claims, demands, losses and costs occurring
during a course of a required placement in the clinical experience arising out of the negligent
acts or omission of the Affiliated Facility or any of its agents, officers or employees.
4.3 Priority Nutrition Care LLC agrees to indemnify and hold harmless the Affiliated Facility for
any damages, losses, claims or demands arising out of the negligent acts or omissions of the
Priority Nutrition Care LLC employees, officers or agents.
4.4 The DIETETIC INTERNS of PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP are not
employees of THE AFFILIATED INSTITUTION. They are not eligible for Worker's Compensation
in case of any injury, and shall not be compensated by THE AFFILIATED INSTITUTION for their
services nor shall they be eligible for any so-called employee benefits provided by THE
AFFILIATED INSTITUTION to its employees.
4.5 Not to discriminate unlawfully on the basis of race, sex, color, creed, national origin, sexual
orientation, religion, handicap, age or disability.
4.6 To confer regularly to discuss methods of improving the program so the transition of
DIETETIC INTERNS into THE AFFILIATED INSTITUTION’s facilities will be smooth and problems
may be resolved cooperatively.
5. TERM AND TERMINATION.
This Agreement shall commence January 13, 2014 and extend until terminated by either party upon
at least thirty (30) days prior written notice, provided that the termination of this Agreement will not
impair the completion of the assignment of any DIETETIC INTERN then assigned to THE AFFILIATED
INSTITUTION.
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6. NOTICES; CONTACTS.
All notices permitted or required hereunder may be sent by regular mail or by facsimile to the
addresses noted below, and the parties shall contact each other to discuss important issues at the
telephone numbers listed below.
If to the PRIORITY NUTRITION CARE LLC:
PRIORITY NUTRITION CARE LLC P.O. BOX 148
HINGHAM, MA 02043
781-264-6877
Attention: Anne Manion MBA, RD. LDN, CDE CEO
If to THE AFFILIATED INSTITUTION:
Maricopa County Head Start
2150-1 S. Country Club Drive Suite #7
Mesa, AZ 85210
480-464-9669 Ext. 201
Attention: Alecia Jackson Interim Head Start Director
Either party may change the address for notice by notifying the other party, in writing, of the new
address.
7. MISCELLANEOUS.
7.1 Section Headings. The section headings contained in this Agreement are for reference
purposes only and shall not affect in any way the meaning or interpretation of this
Agreement.
7.2 Governing Law. This Agreement has been executed and delivered in, and shall be construed
and enforced in accordance with the laws of the Commonwealth of Massachusetts.
7.3 Assignment. Neither Party may assign this Agreement without the prior written consent of
the other Party, provided, however, that the Parties may assign this Agreement (and the
rights and duties hereunder) to another entity that either controls the assigning Party or is
under common control with the assigning Party, or buys all or substantially all of the assets
of the assigning Party, without obtaining the prior written consent of the non-assigning
Party.
7.4 Entire Agreement. This Agreement supersedes all previous contracts or agreements
between the parties with respect to the subject matter hereof, and constitutes the entire
agreement between the parties.
7.5 Amendments. This Agreement may be amended only in writing and signed by an authorized
representative of each party.
7.6 Invalidity of Particular Provisions. If any term or provision of this Agreement, or any
application thereof, to any person or circumstance shall to any extent be invalid or
unenforceable the remainder of this Agreement, or the application of such term or provision
to persons or circumstances other than those as to which it is held invalid or unenforceable,
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shall not be affected thereby and each term and provision of this Agreement shall be valid
and be enforceable to the fullest extent by law.
7.7 Execution. This Agreement and any amendments thereto shall be executed in duplicate
copies by any official of the parties specifically authorized and each duplicate copy shall be
deemed an original but both duplicate originals shall together constitute one and the same
instrument.
IN WITNESS WHEREOF, each of the parties has caused its duly appointed representatives to execute this
Agreement in its behalf.
Approved By: PRIORITY NUTRITION CARE Approved By:
DISTANCE DIETETIC INTERNSHIP MARICOPA COUNTY
___________________________________ ___________________________________
By: Anne S. Manion R.D. Chairman, Board of Supervisors
Title: Chief Executive Officer
__________________ __________________
Date Date
Attested To:
___________________________________
Clerk, Board of Supervisors Date
Approved as to form:
___________________________________
Deputy County Attorney Date
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