CLIENT SERVICES AGREEMENT FOR VASCULAR ACCESS
Prestige Mobile Vascular Access | Agreement Between Client and Provider
This Client Services Agreement (the "Agreement") is entered into and made effective as of , 20 (the "Effective Date"), by and between:
Provider: Prestige Mobile Vascular Access LLC, a Missouri Limited Liability Company, having its principal place of business in Pevely, Missouri ("Provider"), and
Client: ("Client"), with its principal place of business located at .
Client engages Provider, and Provider accepts engagement, to provide specialized, professional, RN-led mobile vascular access and catheter placement services (including PICC line and midline insertions) to patients under the care of Client, as requested by Client and accepted by Provider.
Provider performs services as an independent contractor and is not an employee, partner, or agent of Client. Provider shall be solely responsible for the payment of all federal, state, and local taxes, withholding, unemployment insurance, and social security contributions arising out of Provider's compensation. Provider retains sole control over the manner, methods, and means of performing professional clinical services.
A. Facility Infrastructure:
Client remains strictly responsible for securing valid physician orders, maintaining primary patient medical charts, providing appropriate medical waste disposal infrastructure on-site, and fulfilling all institutional care coordination.
B. Equipment and Supplies Option (Select One):
Option 1 — Provider-Provided Supplies & Equipment: Provider shall ordinarily furnish all specialized insertion tools, clinical equipment, and procedural medical supplies necessary for the performance of vascular access procedures.
Option 2 — Client-Provided Supplies & Equipment: Client elects to supply its own preferred insertion tools, clinical equipment, and medical supplies for procedures. Provider shall utilize Client-provided items, and no additional or extra charges will be assessed by Provider for insertion tools or supplies in such instances.
Client shall compensate Provider for services rendered based upon the selected compensation structure indicated below. Provider shall submit invoices directly to Client via email, and Client shall remit payment in full within thirty (30) days of receipt of invoice.
Compensation Structure (Select One):
Monthly Charge: Client shall pay Provider a monthly retainer fee of $ for all vascular access services rendered during the monthly billing cycle.
Per Patient: Client shall pay Provider a fee of $ per patient procedure successfully completed and documented during the billing cycle.
Provider covenants to maintain active professional malpractice (liability) insurance and general liability insurance throughout the term of this Agreement. Upon request, Provider shall furnish a Certificate of Insurance (COI), current Missouri Registered Nurse license credentials, and IRS Form W-9.
Both parties agree to strictly comply with all applicable federal and state healthcare privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). Each party shall protect the confidentiality of Protected Health Information (PHI) accessed in connection with this Agreement.
This Agreement shall commence on the Effective Date and shall remain in full force and effect until terminated by either party. Either party may terminate this Agreement at any time, with or without cause, upon providing thirty (30) days prior written notice to the other party. Notwithstanding the foregoing, either party may terminate this Agreement immediately upon written notice in the event of an immediate threat to patient safety, loss of professional licensure, or material breach of regulatory compliance.
This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of Missouri, without regard to its conflict of laws principles.
IN WITNESS WHEREOF, the parties hereto have executed this Client Services Agreement as of the Effective Date written above.
PROVIDER:
Prestige Mobile Vascular Access LLC
CLIENT:
[Client / Facility Name]