SIGNATURES OF APPROVAL. Student Internship Site Supervisor MU Supervising Faculty _ Financial Aid Xxxxx School Xxxx- Xx. Xxxxxx Xxxxxxxx Xxxxx Internship Coordinator- Xxxxxx Xxxxxxxx For internships over Winter & Summer Immersion, the contract must be signed by the Immersion/Summer School Xxxx (see signature line below). Tuition will be incurred at the current immersion rate. Immersion/Summer School Xxxx- Dr. Xxxxx Xxxxxx (Xxxxxxxx 209) CONTRACTS ARE DUE BY THE FINAL ADD/DROP DAY OF THAT TERM. Prerequisites for Xxxxx Internship Courses: Accounting Majors: AC251-Intermediate Accounting I Digital Media Marketing Majors: MK200-Principles of Marketing Entrepreneurship Majors: ET340-Foundations of Entrepreneurship Information Systems Majors: IS240-Foundations of Information Systems International Business Majors: BU330-International Business Management Majors: AC230-Intro to Financial Statements BU230-Business Conversations BU250 –Written Business Communications MG300-People and Performance MG370-Operations Management One of the following: MG340-Human Resource Management MG375-Project Management
SIGNATURES OF APPROVAL. 15 The providers responsible for the agreement must sign to formally approve the CPA. State laws vary in allowing a de- signee from an organization to sign for all providers of that organization. The period of validity starts on the day when all signatures have been collected. DATA COLLECTION PLAN A data collection plan must be designed prior to initiation of a CPA. Innovative practices must be measured so that quality can be assured and facets of the program can be improve when needed. Designing the data collection plan prior to implementing the CPA is necessary to the long-term survival of the collaboration between healthcare pro- fessionals. Quality data provides the management team with goals to move the program forward and open the doors for funding opportunities to further solidify the partnership of collaborating organizations. While data collec- tions strategies will vary depending on technology available and disease states managed, the following are sugges- tions of non-clinical data points that can be used to determine the value of using a CPA in a community pharmacy. ESTIMATED COST AVOIDANCE INTERVENTIONS RESOLVED BY CPA The documentation process, discussed previously in this implementation guide, is designed to extract the number and type of interventions that are resolved by CPA. The fax form used to communicate changes to the physician becomes the physical prescription stored in the pharmacy database and scanned in the clinic’s electronic medical record. While retrieval of this paper trail is possible, it is not feasible for an efficient data collection strategy. However, most MTM software platforms have reporting functions designed to export to a spreadsheet. All MTM interventions resolved by CPA should be documented as “resolved by CPA” in the notes of the submitted interventions. By exporting the data from the MTM soft- ware to a spreadsheet, the find option can be used to search for interventions “resolved by CPA.” This process isolates the targeted interventions to yield data including the number and type of interventions resolved by CPA. Healthcare Costs10 The national averages of healthcare ser- vices are ever changing, but current re- search has considered the following val- ues: Physician Visit: 366.73 Additional Medication: 424.33 Emergency Room Visit: 845.25 Hospital Admission: $26,205.40 CPAs can be utilized to prevent these healthcare costs, equating the value of an MTM program with the estimation of costs that were avoided. The ...
SIGNATURES OF APPROVAL. Each xxxxxx below represents that s/he has the requisite authority to enter into this Agreement.
SIGNATURES OF APPROVAL. I, Xx. Xxxxxx Xxxxxxx Eby, a licensed healthcare provider authorized to prescribe medication in the State of Ohio, delegate prescriptive authority to the pharmacists listed below to initiate, modify, refill, and discontinue drug therapy for patients shared by the Good Samaritan Free Health Center (GSFHC) and St. Xxxxxxx xx Xxxx Xxxxxxxxxx Pharmacy (SVDP). This authority pertains to the protocol established in this agreement in accordance with the laws and regulations (ORC 4729.39) of the State of Ohio. SVDP pharmacists shall document all drug therapy adjusted under this protocol and communicate with the healthcare team at GSFHC. As the authorizing prescriber, I or authorized staff under my supervision, will be available to review drug therapy adjustments by SVDP pharmacists. This protocol will be in effect for two years unless rescinded earlier in writing by either party. Any modification of the protocol shall be treated as a new protocol, requiring signed approval from responsible parties. Signatures of Responsible Parties: ______________________________________ 35.044783__________________ ______________ Xx. Xxxxxx Xxxxxxx Eby, MD Medical Director Good Samaritan Free Health Center License Number Date ______________________________________ 03232882-2_________________ ______________ Xx. Xxxxxxx Xxxxxxxxx, RPh Pharmacy Manager St. Xxxxxxx xx Xxxx Xxxxxxxxxx Pharmacy License Number Date ______________________________________ 03334430-3_________________ ______________ Dr. Xxxxx Xxxxxx, RPh Clinical Pharmacist St. Xxxxxxx xx Xxxx Xxxxxxxxxx Pharmacy License Number Date ______________________________________ 03110884-1_________________ ______________ Xx. Xxxx Xxxxx, RPh Pharmacy Director St. Xxxxxxx xx Xxxx Xxxxxxxxxx Pharmacy License Number Date
SIGNATURES OF APPROVAL. I, [medical director], a licensed healthcare provider authorized to prescribe medication in the State of [state], delegate prescriptive authority to the pharmacists listed below to initiate, modify, refill, and discontinue drug therapy for patients shared by the [physician practice] and [community pharmacy]. This authority pertains to the protocol established in this agreement in accordance with all state laws and regulations. Pharmacists shall document all drug therapy adjusted under this protocol and communicate with the healthcare team. As the authorizing prescriber, I or authorized staff under my supervision, will be available to review drug therapy adjustments by pharmacists. This protocol will be in effect for two years unless rescinded earlier in writing by either party. Any modification of the protocol shall be treated as a new protocol, requiring signed approval from responsible parties. Signatures of Responsible Parties: [medical director name] Medical Director [physician practice] License Number Date
SIGNATURES OF APPROVAL. Obtain signatures in order Student Signature Date Student’s Department Head Signature Date Instructor Signature Date ME Graduate Chair Signature Date Instructor’s typed name and e-mail address Date XXX Graduate Academic Xxxx Signature Date Graduate Coordinator Signature Date ME INDEPENDENT STUDY PROPOSAL (Please feel free to add additional pages if needed) TITLE: Description & Reason for Course: MAJOR MEASURABLE LEARNING OBJECTIVES Expectations: Grading: Resources:
SIGNATURES OF APPROVAL. THE PARTIES, INTENDING TO BE LEGALLY BOUND, have executed this amendment on the date first set forth above. DCFS Xxxx Xxxx Director, Data, Systems & Evaluation Signature Date Name Title USBE Xxxxxx Xxxxxxx, Xx.D State Superintendent of Public Instruction Signature Date Name Title USBE CONTACT PERSON: Name/Title: Phone/email: 000-000-0000, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx Xxxx Xxxxxxx, Director of Privacy, USBE Draft 1 August 21, 2023 Contact: Xxxx Xxxxxxx, Director of Privacy, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx This amendment is for consideration in the September 2023 Law and Licensing Committee meeting.
SIGNATURES OF APPROVAL. THE PARTIES, INTENDING TO BE LEGALLY BOUND, have executed this amendment on the date first set forth above. L2TReC Xxxxxxxx Xxxxx Director Signature Date Name Title USBE Xxxxxx Xxxxxxx, Ed.D State Superintendent of Public Instruction Signature Date Name Title USBE CONTACT PERSON: Name/Title: Phone/email: 000-000-0000, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx Xxxx Xxxxxxx, Director of Privacy, USBE
SIGNATURES OF APPROVAL. THE PARTIES, INTENDING TO BE LEGALLY BOUND, have executed this amendment on the date first set forth above. L2TReC Xxxxxxxx Xxxxx Director Signature Date Name Title USBE Xxxxxx Xxxxxxx, Ed.D State Superintendent of Public Instruction Signature Date Name Title USBE CONTACT PERSON: Name/Title: Phone/email: 000-000-0000, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx Xxxx Xxxxxxx, Director of Privacy, USBE 1 Date: April 25, 2023 Version: 1 Contact Person and Email: Xxxx Xxxxxxx, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx
SIGNATURES OF APPROVAL. THE PARTIES, INTENDING TO BE LEGALLY BOUND, have executed this amendment on the date first set forth above. Researcher Xxxxxxx Xxxxxxxx Researcher Signature Date Name Title USBE Xxxxxx Xxxxxxx, Xx.D State Superintendent of Public Instruction Signature Date Name Title USBE CONTACT PERSON: Name/Title: Phone/email: 000-000-0000, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx Xxxx Xxxxxxx, Director of Privacy, USBE Draft number: 1 Contact Information: Xxxx Xxxxxxx, xxxx.xxxxxxx@xxxxxxx.xxxx.xxx This amendment is for consideration in the September 2023 Law and Licensing Committee meeting.
