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 “B” Appendix 1 BASIC SUPPLY KIT QUANTITY Reinforced gown 1 Surgical mask 3 Gloves 3 Liners 2 Scaple blades (#10, #15, #20) 3 Amp pad 1 Light handles 1 Cautery pads 2 Blue pads 3 Scrub sponge 2 Surgical pre-solution 1 Medical Lines 1 Mayo stand cover 1 Sponge, gauze x-ray 1 Syringe, 20ml l/lock, w/o shie 1 Bag 1 Drape, sheet 2 Ruler, 6" flex 1 Patient ID Band 1 IV Bags of Ringers 1 Gown, large w/ towel 1 Black table cover, unfolded 1 Bouffant Cap for patient 1 Booties for patient 2 IV Tubing 1 Gauze, sponge 5 Marker, lab blk "not for skin 1 Needle, 20g x3.5" spinal 1 Sutures 1 Drains 2 Methylene blue 1 Marking pen 1 Saline 1 Scrub sponge 2 Mop head 1 20 cc syringe 2 Suction tubing and tip 1 Ett 1 Angiocatheter 1 Filter 1 Oral airway 1 Needle magnet 1 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 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 “BA” Appendix 1 BASIC SUPPLY KIT QUANTITY Reinforced gown 1 Surgical mask 3 Gloves 3 Liners 2 Scaple blades (#10, #15, #20) 3 Amp pad 1 Light handles 1 Cautery pads 2 Blue pads 3 Scrub sponge 2 Surgical pre-solution 1 Medical Lines 1 Mayo stand cover 1 Sponge, gauze x-ray 1 Syringe, 20ml l/lock, w/o shie 1 Bag 1 Drape, sheet 2 Ruler, 6" flex 1 Patient ID Band 1 IV Bags of Ringers 1 Gown, large w/ towel 1 Black table cover, unfolded 1 Bouffant Cap for patient 1 Booties for patient 2 IV Tubing 1 Gauze, sponge 5 Marker, lab blk "not for skin 1 Needle, 20g x3.5" spinal 1 Sutures 1 Drains 2 Methylene blue 1 Marking pen 1 Saline 1 Scrub sponge 2 Mop head 1 20 cc syringe 2 Suction tubing and tip 1 Ett 1 Angiocatheter 1 Filter 1 Oral airway 1 Needle magnet 1 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 Definitions1