REGIS COLLEGE AFFILIATION AGREEMENT - PENDING BOS SIGNATURE.PDF
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235 Wellesley Street
Weston, MA 02493
781.768.7000
regiscollege.edu
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REGIS COLLEGE
CLINICAL/FIELDWORK AGREEMENT
This Clinical/Fieldwork Agreement (“Agreement”) dated 10/27/2021 is executed by and between Regis College
(“Regis”) located at 235 Wellesley Street, Weston, MA 02493 and Maricopa County (“Host Agency”) located at
3250 W Lower Buckeye Rd, Phoenix, AZ 85009.
WHEREAS, Regis desires to provide to its students a supervised clinical and/or fieldwork practice experience in
the practice areas of Nurse Practitioner through the application of classroom knowledge and skills in actual
patient or client centered situations (“the Program”), and;
WHEREAS, Host Agency has agreed to make its facility available to Regis for such purposes.
NOW THEREFORE, in consideration of the mutual promises contained herein, the parties hereby agree as
follows.
I.
Responsibilities of Regis
A. Regis will prepare students selected for the Program for effective participation at Host Agency’s facility.
Regis shall select students who have satisfied Regis’ academic and other requirements, including
completion of all necessary prerequisite courses and previous clinical experiences. Regis will retain
ultimate responsibility for the education of students.
B. Regis shall provide Host Agency with current information about its curriculum and the educational
objectives and requirements goals of the Program on Host Agency’s request.
C. Regis will require all students to maintain health insurance throughout their participation in the Program
and to provide proof of such health insurance to Regis.
D. Regis will perform a criminal background check on students assigned to Host Agency. Regis will inform the
student of their responsibility to provide their criminal background check records to Host Agency upon
Host Agency’s request. Where Host Agency has requested criminal background check records, Host Agency
will determine whether a student may participate in the Program on its premises.
E. Regis will inform students that they may be required to undergo a drug test or other similar screening tests
pursuant to Host Agency’s policies and practices.
F. Regis will verify that students have received the immunizations and/or medical procedures listed in Exhibit
A, attached hereto and hereby incorporated by reference and will inform the student of his/her
responsibility to provide evidence to Host Agency of any required immunizations, when requested.
G. Regis will advise students that they are required to comply with Host Agency rules, regulations, and
procedures.
H. Regis will designate a coordinator to oversee and coordinate the administration of the Program on behalf
of Regis.
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Weston, MA 02493
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I.
Regis maintains general liability insurance with maximum coverage limits of at least $1,000,000 per
occurrence and $3,000,000 aggregate. Regis provides professional liability coverage for its professional
staff and for students with a maximum coverage limit of at least $1,000,000.
J. Regis will inform each student assigned to the Program of the Student Responsibilities and
Acknowledgements listed in Exhibit B attached hereto and hereby incorporated by reference.
K. Where possible, Regis faculty may make periodic site visits to Host Agency to meet with students and Host
Agency staff. Regis shall make faculty or administrators available during normal business hours to respond
to questions or problems arising at Host Agency that cannot be addressed on site.
II.
Responsibilities of Host Agency
A. Host Agency has a responsibility to maintain a positive, respectful, safe, and adequately resourced learning
environment so that sound educational experiences can occur. Therefore, Host Agency will provide
students with access to appropriate resources for student education including, but not limited to:
i.
Access to patients or clients at Host Agency facilities in an appropriately supervised environment;
ii.
Security badges or other required security access to patient or client care areas;
iii.
Access to and required training in the proper use of electronic medical records or paper charts, as
applicable;
iv.
Computer access;
v.
Information regarding Host Agency facilities, transportation, polices, and other such information as
be necessary for students to participate in the Program;
vi.
Information regarding Host Agency policies on the protection of confidential information.
B. Host Agency will retain full responsibility for care of patients or clients.
C. The responsibility of Host Agency for patient or client care should not diminish or preclude opportunities
for students to undertake patient or client care duties under appropriate supervision.
D. Host Agency staff will assist Regis in the evaluation of the learning and performance of students by
completing evaluation forms provided by and returned to Regis in a timely fashion. If requested by Host
Agency, Regis will provide instruction to Host Agency's staff with respect to the evaluation of Regis’
students.
E. Host Agency will provide for the orientation of Regis’ students as to Host Agency's rules, regulations,
procedures, and policies including, but not limited to, practices related to the Health Insurance Portability
and Accountability Act (“HIPAA”), practices related to Occupational Safety and Health Administration
(“OSHA”) regulatory compliance, and infection control.
F. In the event a student is exposed to an infectious or environmental hazard or other occupational injury
(e.g. needle stick or blood exposure) while at Host Agency, Host Agency will provide such emergency care
as is provided its employees. If Host Agency does not have the resources to provide such emergency care,
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Weston, MA 02493
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Host Agency will refer such student to the nearest emergency facility. The student will be responsible for
all medical expenses, including future medical expenses, related to such injury, illness, or exposure. Host
Agency may subject student to any applicable return to service health requirements following such injury,
illness, or exposure.
G. Host Agency, its employees, agents and representatives shall maintain in confidence student files,
education records, and personal information in accordance with the Family Educational Rights and Privacy
Act of 1974 (“FERPA”) and other applicable law or regulation. Host Agency will limit access to such student
information to only those employees and agents with a professional need to access such information for
the purposes of this Agreement.
H. Upon request, Host Agency will provide proof that it maintains liability insurance in an amount that is
commercially reasonable and/or as required by law.
I.
Host Agency will promptly provide written notification to Regis if a claim arises involving a student.
J. Host Agency will resolve any situation in favor of patient or client welfare and will restrict a student to the
role of observer if a problem may arise and until the problem can be resolved by the staff in charge of the
student or the student is removed. Host Agency will notify Regis if such an action is required.
K. Host Agency shall identify a site coordinator from among its staff who will communicate and cooperate
with Regis regarding the administration of the Program at Host Agency.
L. Host Agency shall provide qualified personnel to provide on-site clinical supervision of students at Host
Agency. Regis will not provide on-site clinical supervision of students.
III.
Mutual Responsibilities
A. The parties will work together to maintain an environment of high-quality patient or client care. At the
request of either party, a meeting or conference will promptly be held between Regis and Host Agency
representatives to resolve any problems or develop any improvements in the operation of the Program.
B. Regis and Host Agency will not discriminate against any employee, applicant to the Program or student
because of age, disability, national origin, race, ethnicity, religion, sex, gender identity, sexual orientation
or any other basis protected by law.
C. Host Agency may request the removal of any student or faculty (where applicable) who Host Agency
determines is not performing in accordance with its applicable administrative and patient or client care
policies, procedures, rules, and/or regulations. Host Agency must make such request to Regis in writing
and must include a statement of the reason or reasons why Host Agency desires to have the student or
faculty (where applicable) removed. Regis and Host Agency must afford the student or faculty (where
applicable) an opportunity to respond in writing to the stated reasons for their removal from Host Agency.
However, Host Agency may immediately remove from the premises any student or faculty (where
applicable) who poses an immediate threat or danger to personnel or to the quality of patient or client
services, or for unprofessional behavior. Regis may terminate a student's or faculty’s (where applicable)
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participation in the Program when, in Regis’ sole discretion, further participation by the student or clinical
faculty would no longer be appropriate.
D. In collaboration with Regis, Host Agency will provide reasonable workplace accommodations for students.
IV.
Location of Host Agency Site(s)
Students shall participate in the Program at the following Host Agency site(s) and such other sites as the
parties may subsequently agree in writing:
Maricopa County Sheriff’s Office - Lower Buckeye Jail
3250 W Lower Buckeye Rd
Phoenix, AZ 85009
V.
Term and Termination
A. This Agreement will commence upon execution by both parties and will terminate on 12/31/2022.
(“Termination Date”). Unless either party provides the other with ninety (90) days’ prior written
notice, this Agreement will automatically renew for one (1) additional [five (5) year] renewal term on
the Termination Date. This Agreement may be terminated at any time and for any reason by either
party upon not less than ninety (90) days’ prior written notice to the other party. Should notice of
termination be given under this section, students then assigned to Host Agency will be permitted to
complete any previously scheduled assignment at Host Agency.
B. This Agreement is subject to cancelation pursuant to A.R.S. § 38-511.
VI.
Employment Disclaimer
With regard to their participation in the Program, students will not be considered employees or agents of Host
Agency or Regis for any purpose except as provided for in Section VIII. In connection with the Program,
Students will not be entitled to receive any financial or other compensation from Host Agency or Regis or any
benefits of employment from Host Agency or Regis, including but not limited to, health care or workers'
compensation benefits, vacation, sick time, or any other benefit of employment, direct or indirect. Students
participate in the Program to gain clinical/field work experience as a means of fulfilling academic
requirements. Students may not replace or substitute for an employee of Host Agency. Host Agency will not be
required to purchase any form of insurance for the benefit or protection of any student of Regis. Student
participation in the Program includes no expectation of subsequent employment with Host Agency.
VII.
Health Insurance Portability and Accountability Act; Private Health Information.
A. Students participating in the Program pursuant to this Agreement are members of Host Agency’s
workforce for purposes of the Health Insurance Portability and Accountability Act (“HIPAA”) within the
definition of “health care operations” and therefore may have access to patient or client medical or health
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information as provided for in the Privacy Rule of HIPAA. Therefore, additional agreements are not
necessary for HIPAA compliance purposes. This paragraph applies solely to HIPAA privacy and security
regulations applicable to Host Agency and, as stated in Section VII, above, does not establish an
employment relationship.
B. Host Agency shall not disclose any private medical or health information to Regis pursuant to this
Agreement.
VIII.
No Agency Relationship Between the Parties.
Nothing in this Agreement is intended to or shall be construed to constitute or establish an agency,
employer/employee, partnership, franchise, joint venture or fiduciary relationship between the parties, but
rather is an agreement between independent contractors. Neither party shall have the right or authority or
shall hold itself out to have the right or authority to bind the other party, nor shall either party be responsible
for the acts or omissions of the other except as provided specifically to the contrary herein.
IX.
Assignment
This Agreement may not be assigned by either party without the prior written consent of the other party.
X.
Notices
All notices provided by either party to the other will be in writing and will be deemed to have been duly given
when delivered personally, when deposited in the United States mail, First Class, postage prepaid, or via e-mail
(upon confirmation of receipt) addressed to the individuals indicated below. The parties may from time to time
designate such other persons or contact information by written notice to the other.
If to Regis:
Vanessa Plantz
Clinical Placement Coordinator
Regis College Nurse Practitioner Program
235 Wellesley Street, CH 121
Weston, MA 02943
Vanessa.plantz@regiscollege.edu
If to Host Agency:
Donna Campbell, RN, CCHP
Education Nursing Supervisor
Maricopa County Sheriff’s Office - Lower Buckeye Jail
3250 W Lower Buckeye Rd
Phoenix, AZ 85009
Donna.Campbell@Maricopa.gov
XI.
Indemnification
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Weston, MA 02493
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Regis and Host Agency (“Indemnifying Party”) agree to indemnify and hold harmless the other party and its
employees, directors, officers, and/or agents (collectively, the “Indemnified Party”) from and against all third
party claims, demands, actions, suits, damages, liabilities, losses, settlements, judgments, costs and expenses
(including but not limited to reasonable attorney’s fees and costs), arising out of the grossly negligent acts or
omissions by either party during the Term of this Agreement. The Indemnified Party shall notify the
Indemnifying Party of any claim which might result in a request for indemnification under this section.
XII.
Limitation of Liability
IN NO EVENT SHALL EITHER PARTY BY LIABLE UNDER THIS AGREEMENT TO THE OTHER PARTY FOR ANY
INCIDENTAL, CONSEQUENTIAL, INDIRECT, STATUTORY, SPECIAL, EXEMPLARY OR PUNITIVE DAMAGES,
INCLUDING, BUT NOT LIMITED TO, LOST PROFITS, LOSS OF USE, LOSS OF TIME, INCONVENIENCE, LOST
BUSINESS OPPORTUNITIES, DAMAGE TO GOOD WILL OR REPUTATION, AND COSTS OF COVER, REGARDLESS OF
WHETHER SUCH LIABILITY IS BASED ON BREACH OF CONTRACT, TORT, STRICT LIABILITY OR OTHERWISE, AND
EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES OR SUCH DAMAGES COULD HAVE BEEN
REASONABLY FORESEEN. THIS SECTION SHALL SURVIVE THE TERMINATION OF THE AGREEMENT.
XIII.
No Payments
No payments shall be made between the parties or made to the students in connection with this Agreement.
Where Host Agency staff complete enough hours of on-site clinical supervision of students, Regis may grant
Host Agency or the individual staff a Course Credit Voucher.
XIV.
Severability
The invalidity of any provision of this Agreement will not affect the validity of any other provisions.
XV.
Headings
Headings in this Agreement are for convenience only.
XVI.
Entire Agreement; Amendment
This Agreement contains the entire agreement of the parties as it relates to this subject matter and supersedes
and cancels all previous agreements between the parties. Regis and Host Agency may review this Agreement
on an annual basis. This Agreement may be amended only in writing and executed by both parties.
XVII.
Governing Law
This Agreement and any disputes related to this Agreement shall be governed by the laws of the State of
Arizona without regard to its conflict of law principles.
XVIII. Counterparts
235 Wellesley Street
Weston, MA 02493
781.768.7000
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This Agreement may be executed in one or more counterparts, each of which will be deemed to be an original,
but all of which together will constitute one and the same instrument, without necessity of production of the
others. An executed signature delivered via facsimile, e-mail, or PDF format shall create a valid and binding
obligation of the executing party and shall be deemed an original signature for all purposes under this
Agreement.
IN WITNESS WHEREOF, each of the parties has caused its duly appointed representatives to execute this
Agreement on its behalf.
REGIS COLLEGE
MARICOPA COUNTY
By : ____________________________
By:______________________________
Name:_________________________
Name: __________________________
Title: __________________________
Title: Chairman, Board of Supervisors
Date:______________________
Date:_____________________
ATTESTED TO:
By: ________________________________
Name: ______________________________
Title: Clerk of the Board
Date: _______________________________
APPROVED AS TO FORM:
By: ________________________________
Name: ______________________________
Title: Deputy County Attorney
Date: _____________________________
Karin Oliveira
Director, Clinical Programs
Nursing Administration
12/14/2021
Wayne J. Peck
December 15, 2021
235 Wellesley Street
Weston, MA 02493
781.768.7000
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Exhibit A – Immunizations and Examination Requirements
Immunization and Medical Exam Requirements:
1. Measles, Mumps & Rubella (MMR): Positive antibody titers for all 3 components (lab report required) 2
injections.
2. Varicella (Chicken Pox): Positive antibody titer (lab report required) 2 injections, history of disease is NOT
acceptable.
3. Hepatitis B” Positive antibody titer (lab report required). Or 3 Hepatitis B vaccination series.
4. Tuberculosis (TB): Evidence of two (2) negative Tuberculosis Skin Tests (TST). Students with a history of a
positive TST must provide documentation of a negative chest x-ray within the past one year and must
provide documentation of an annual symptom review for active TB disease. Students with a history of a
positive TST who are originally from a TB-endemic country (as defined by the Centers for Disease Control)
and/or a history of BCG vaccine, must provide documentation of a negative blood assay Mycobacterium
tuberculosis test (QFT or T-spot) lab test. If the QFT or T-spot is positive, a subsequent chest x-ray which
rules out active TB disease and documentation of an annual symptom review for active TB disease is
required.
5. Tetanus, Diphtheria & Pertussis (Tdap): There must be documentation of a Tdap booster within the past 10
years.
6. Documentation of a flu shot administered during the current flu season. No later than October.
7. Physical Examination form completed and signed by a medical professional.
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Weston, MA 02493
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Exhibit B – Student Responsibilities and Acknowledgements
1. Student will notify appropriate Regis staff in a timely fashion of any concerns or developments affecting
participation in their clinical/fieldwork placement (“Placement”) before, during, or after the Placement
experience.
2. Student will observe all rules, regulations, and policies of their Placement site (“Host Agency.”)
3. Student will maintain patient and/or client confidentiality in accord with the Health Insurance Portability
and Accountability Act (“HIPAA”), other applicable law, and Host Agency rules, regulations, and policies.
Student understands that this obligation continues after the completion of their Placement experience.
4. Student will maintain the confidentiality of Host Agency information, records, and documents.
5. Student will receive no financial or other compensation for participation in their Placement experience at
Host Agency.
6. Student must maintain health insurance throughout their participation in the Placement experience.
7. Student is not an employee of Regis College or Host Agency for any purpose including, but not limited to,
workers’ compensation claims.
8. Student understands that there is no expectation of employment with Host Agency at the conclusion of
their participation in the Placement experience at Host Agency.
9. Student is responsible for all medical expenses, including future medical expenses, associated with any
occupational injury, illness, or exposure experienced at Host Agency. Host Agency may subject Student to
any applicable return to service health requirements following such injury, illness, or exposure.
10. Students are encouraged to self-disclose any need for workplace accommodations to Host Agency.
11. Student acknowledges that Regis may need to disclose Student’s immunization, criminal background,
alcohol or drug tests, or other information to Host Agency for the purposes of arranging their Placement.
12. Student understands that they must obtain all necessary permissions and consents (from Host Agency,
patients, and/or clients) before including information from their Placement in their academic or scholarly
work.
13. Student understands that failure to comply with any Host Agency or Regis rules or requirements may
result in their dismissal from Host Agency and failure of the related component or course within their
academic curriculum.