SUBCONTRACTS AND "DOWNSTREAM Clause Samples

SUBCONTRACTS AND "DOWNSTREAM. ENTITIES. APS shall ensure that all of the requirements set forth in this Attachment that are applicable to MHSA Providers and/or "downstream" entities with whom APS contracts or any downstream entity to whom APS delegates any of its obligations under the Agreement (as authorized pursuant to this Agreement with CHC) shall be incorporated into APS' contract with such provider or entity. APS shall enforce those provisions in its contracts to the fullest extent of the law. [PLAN NAME: ADVANTRA MEMBER AUTHORIZATION TO PERFORM NON-COVERED SERVICES I have requested that my provider, _____________, furnish me with the following (Name) services: My provider has informed me that the services listed above are not covered under my [PLAN NAME] Advantra Evidence of Coverage. My signature below indicates that I agree to accept responsibility for payment for such non-covered services and hold harmless [PLAN NAME] for such payment. ---------------------------- -------------------------- SIGNATURE OF PATIENT DATE ---------------------------- PRINTED NAME OF PATIENT ATTACHMENT H PRINTED MATERIALS See attached EAP Inventory. 6J97 EAP Inventory Form #Form Name Quantity Available -------------------------------------------------------------------------------- PH 848-1 EE Brochure 605295 PH 1003 Stuffer-Legal 409028 PH 1004 Stuffer-Parenting 409320 PH 1005 Stuffer-Alcohol 316713 PH 1006 Stuffer-Relationships 325226 PH 1289 Stuffer-Childcare 20946 1 PH 1290 Stuffer-Eldercare 2098 PH 1613 Stuffer-Parenting 154 PH 1614 Stuffer-Alcohol 189 PH 1639 ER Question Letter 97382 PH 1827 ER Brochure-Nippon 3787 PH 1829 EE Brochure Raytheon Wichita ▇▇▇ ▇▇▇▇▇, PHC, WICHITA PH 1830 EE Brochure Raytheon Phone Only ▇▇▇▇▇ ▇▇▇▇▇▇▇, PBHC PH ▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ < 200 16999 PH 1946 EAP Brochure (revised PH 848-I) 847150 PH 1948 Over-extended brochure 849989 (revised PH 1003) PH 1949 Trapped Brochure (revised PH 1005) 849998 PH 1950 Stranger Brochure (revised PH 1004) 99990 PH 1951 No 2 Alike Brochure (revised PH 1006) 99990 PH 1952 Juggling Brochure (revised PH 1289) 99924 PH 1953 Squeezed Brochure (revised PH 1290) 24000 PH 1962 Over-extended Brochure Raytheon 24848 PH 1964 Stranger Brochure Raytheon 12481 PH 1966 Trapped Brochure Raytheon 25024 PH 1968 No 2 Alike Brochure Raytheon 24990 PH 1970 Juggling Brochure Raytheon 10903 PH 1972 Squeezed Brochure Raytheon 28189 If the whole order was sent to CHC, it will not be listed at the R/S Center. AGREEMENT FOR THE DELEGATION OF CREDENTIALING ACTI...