Common use of Unplanned Transfer to Hospital Clause in Contracts

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “C” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Definitions

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility CSF to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “C” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000403-000-0000 282- 8223 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000403-000-0000 282- 8223 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000403-000-0000 282- 8223 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000403-000-0000 282- 8223 pager# 08888 Definitions

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate ophthalmology colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “C” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. : xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxxxxx.xx/TakeSurvey During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Definitions

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “C” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. : xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxxxxx.xx/TakeSurvey During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Definitions

Unplanned Transfer to Hospital. CPSM COPY For Clients requiring emergency transfer from the Facility CSF to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “C” INCIDENT REPORTING PROCESS Process CPSM COPY Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Definitions

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate ophthalmology colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. SCHEDULE “CB” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. During non-business hours: AHS Admin on Call 000-000- 000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000- 000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000- 000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000- 000-0000 pager# 08888 Definitions

Unplanned Transfer to Hospital. For Clients requiring emergency transfer from the Facility to an acute care hospital, the Service Provider shall ensure that the attending physician or anesthesiologist shall directly communicate this transfer to an appropriate orthopedic colleague or emergency room physician of the receiving hospital. Client care information must accompany the Client to the hospital. This shall include, but not be limited to, copies of the following: history and physical exam record; consultation records; diagnostic records (lab reports, appropriate x-rays; ECG, etc.); anesthetic record (if applicable); operating room; and recovery room nursing records (if applicable). Emergency Medical Services (EMS) transportation costs will be paid by AHS with invoice submission required, only for Clients that require an unplanned transfer to an emergency department and/or admission to hospital. APPENDIX B-1 [SAMPLE] CONSTRUCTION AND PROGRESS UPDATE Development Timetable Confirm if already completed Actual or Estimated Completion Date YYYY -MMM Progress Updates 1 Financing 3 Land Use - Subdivision or Re-Zoning 4 Environmental Review 5 Development Permit 6 Land Purchase/Land Lease Negotiations/Land Secured 7 Building Permit 8 Construction Tender 9 Construction Commencement 10 Substantial Construction Completion 11 Occupancy Permit APPENDIX B-2 [SAMPLE] KEY CONSTRUCTION MILESTONES SCHEDULE “C” INCIDENT REPORTING PROCESS Process Service Providers are required to report all situations where Clients have suffered harm or experienced close calls and any hazards that could lead to Client harm in accordance with the following grid: Event When to Report How to Contact AHS Hospital Transfers To be reported immediately, and quarterly reporting of aggregate data, irrespective of level of Harm During Business Hours: Submit incident via AHS’ online reporting tool. : xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxxxxx.xx/TakeSurvey During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Severe Harm (critical incident) To be reported immediately, and quarterly reporting of aggregate data, immediately in reasonable detail, with follow up report in complete detail to be submitted within 24 hours of event During Business Hours: Submit incident via AHS’ online reporting tool. : xxxxx://xxxxxx.xxxxxxxxxxxxxxxxxxxxx.xx/TakeSurvey .aspx?SurveyID=NHSFIncidents# During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Moderate and Minimal Harm To be reported in complete detail within 72 hours of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 No Apparent Harm, Hazards and Close Calls To be reported in complete detail within 30 days of event and quarterly reporting of aggregate data During Business Hours: Submit incident via AHS’ online reporting tool. tool During non-business hours: AHS Admin on Call 000-000-0000 pager# 08888 Definitions