Common use of TRANSPORT AND BACKUP Clause in Contracts

TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at (Name of Hospital) (Phone Number) is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at immediately (Name of Physician) (Phone Number/s)) (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. Date Physician's Signature (Required) Physician's Printed Name Date Physician Assistant's Signature (Required) Physician Assistant's Printed Name SUPERVISING PHYSICIAN'S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISOR , M.D./D.O. is licensed to practice in California as a physician and surgeon with medical license number . Hereinafter, the above named physician shall be referred to as the supervising physician.

TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at (Name of Hospital) (Phone Number) is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at immediately (Name of Physician) (Phone Number/s)) (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. Date Physician's Signature (Required) Physician's Printed Name Date Physician Assistant's Signature (Required) Physician Assistant's Printed Name SAMPLE ONLY SUPERVISING PHYSICIAN'S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISOR , M.D./D.O. is licensed to practice in California as a physician and surgeon with medical license number . Hereinafter, the above named physician shall be referred to as the supervising physician.

TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at (Name of Hospital) (Phone Number) is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at immediately (Name of Physician) (Phone Number/s)) (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. Date Physician's Signature (Required) Physician's Printed Name Date Physician Assistant's Signature (Required) Physician Assistant's Printed Name SAMPLE ONLY SUPERVISING PHYSICIAN'S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISOR , M.D./D.O. is licensed to practice in California as a physician and surgeon with medical license number . Hereinafter, the above named physician shall be referred to as the supervising physician.

TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at (Name of Hospital) (Phone Number) is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at immediately (Name of Physician) (or within minutes). (Phone Number/s)) (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. Date Physician's Signature (Required) Physician's Printed Name Date Physician Assistant's Signature (Required) Physician Assistant's Printed Name SAMPLE ONLY SUPERVISING PHYSICIAN'S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISOR , M.D./D.O. is licensed to practice in California as a physician and surgeon with medical license number . Hereinafter, the above named physician shall be referred to as the supervising physician.