Clinical Affiliation Agreement

Clinical Affiliation Agreement

_____________________________ (hereafter "Institution") and _______________________ (hereafter "Affiliate") hereby agree to the following:

Whereas the Institution and the Affiliate are both desirous of having medical students in a {number}-year program attain clinical experience outside of the Institution, the agreement outlined below will be made with good faith between both parties, neither of whom will ask for or receive compensation.

The agreement will begin on {date} and extend to {date}. After that time an extension of {amount of time} may be agreed upon by both parties. Either party may withdraw from the agreement with {amount of time} notice.

The Institution will provide {number} students in the {type} program per {term/semester}, all of whom will complete their work at {Facility Name} (hereafter "Facility") for the duration of the {term/semester}.

The Affiliate will provide all necessary outfitting and equipment for the students to perform at the Facility. The Affiliate will maintain sufficient staff in addition to the students and provide adequate supervision over the students during their rotations. The Affiliate maintains complete responsibility for the care and safety of its patients at the Facility.

The {Institution/Affiliate} will select the students each {term/semester} based on the following standards: {Standards}.

The {Institution/Affiliate} will provide training, orientation and scheduling at the Facility for incoming students.

The Affiliate will provide training in an emergency situation and treat students for any injury or illness they obtain at the Facility. The cost the training and care will be covered by the {Affiliate/Institution/Student}.

The Affiliate will maintain accreditation and all required permits at its own cost and provide documentation of such to the Institution when called upon. Both parties agree to follow all local, health, state and federal laws.

The Affiliate agrees to extend to students all non-discriminatory workplace and hiring practice laws. The Affiliate may dismiss students, but they must provide the Institution with documentation of proper discipline and cause of dismissal.

In witness to their agreement to the terms of this contract, the parties affix their signatures below:

_____________________________________
(Affiliate signature and date)

_____________________________________
(Institution signature and date)

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