Cpap Technician Contract (1099 Independent Contractor)

CPAP TECHNICIAN CONTRACT (1099 INDEPENDENT CONTRACTOR)

This CPAP Technician contract (“Agreement”) is made as of ______(the “Effective Date”) by and between, ______with an address at, ______, (“CPAP Technician”), and CPAP Medical with an address at 6950 Philips Highway #36, Jacksonville, FL 32216, (“Company”)

Party-1 agrees to perform these services for CPAP Medical under the terms and conditions set forth in this contract.

1. The supervision, direction, and assessment of services between CPAP Medical, the patient, and CPAP Technician will be the responsibility of CPAP Medical.

2. In which the CPAP Technician is a Respiratory Therapist that is either Certified or Registered, and licensed in the state of ______(If your state does not require a license just write “N/A”). CPAP Technician will be familiar with demonstrating the CPAP equipment, including sizing, instructions, and education with a setup in the patients home or other location agreeable to the patient.

3. This agreement will not affect a patient’s freedom to choose their own provider.

In consideration of the mutual promises set forth in this contract, it is agreed by and between CPAP Technician and Company:

1. RESPONSIBILITIES OF CPAP TECHNICIAN

(a) Adhere to CPAP Medical policies and procedures regarding patient care and servicing of the patient

(b) Contact patient and arrange a time, day, and location that is convenient for the patient.

(c) CPAP Technician is competently trained and experienced with all CPAP equipment, whether operating or maintaining the equipment.

(d) It is the responsibility of CPAP Technician to maintain and comply with all federal and state requirements and provide to company all documentation of such compliance.

(e) If CPAP Technician is a licensed or registered Respiratory Therapist, CPAP Technician will maintain all state and federal licenses to practice as a Licensed or Registered Respiratory Therapist. It is the responsibility of the CPAP Technician to make sure they have reviewed and are compliant with all state and federal licensing.

(f) To maintain all documents required by law, CPAP Medical, or third party payers.

Required CPAP Medical Documents:

(i) Delivery Ticket

(ii) Authorization to Disclose Protected Health Information

Required Documents to be provided to patient:

(iii) CPAP Medical Letter

(iv) Therapeutic Effect of CPAP

(v) Cleaning Instructions

(vi) Medicare payment for your PAP Equipment (if applicable)

(vii) Summary of rights and responsibilities

(viii) 30 Supplier Standards

(ix) HIPAA Notice of Privacy Practices

(x) Billing Rates

2. RESPONSIBILITIES OF COMPANY:

(a) Provide all policies and procedures to the CPAP Technician

(b) Communicate the needs of the CPAP patient and any other information needed from the referral source to the CPAP Technician

3. INSURANCE

(a) If CPAP Technician carries professional liability and/or malpractice insurance they must provide a copy to company.

4. TERM

(a) The term of this Agreement is for one (1) year from the date of signing.

(b) The Agreement will automatically renew for additional terms of one (1) year unless either party elects to terminate the agreement.

5. CONFIDENTIALITY

(a) Disclosures of Confidential information made by CPAP Technician and Company, are pursuant to all terms and conditions of this Agreement. All Confidential Information of the disclosing party will remain the exclusive property of the disclosing party. The terms and conditions of this Agreement are deemed to be Confidential Information of both parties.

(b) After request by the disclosing party, and after termination of this Agreement, receiving party must within thirty (30) days return or destroy all Confidential Information of the disclosing party.

CPAP TECHNICIAN

By: ______

Print Name: ______

Address: ______

______

COMPANY (CPAP MEDICAL)

By: ______

Print Name: ______

Address: ______

______