Transfer Agreement

TRANSFER AGREEMENT

Whereas, The parties of this agreement desire in the interest of good resident care in securing optimum use of the nursing facility and the hospital; to assure continuity of care and treatment appropriate to the needs of each resident; to use the skills, resources and physical plant of both parties in a coordinated and cooperative manner to improve care at the acute and post acute stages of illness.

NOW, THEREFORE IN CONSEDERATION of the mutual advantages occurring to the parties hereto, ______and ______hereby covenant and agree with each other as follows:

(A)Nothing in the Agreement shall in any way alter the freedom enjoyed by either facility, nor shall it in any way affect the independent operation of either facility. Neither party by virtue of this Agreement assumes any liability for any debts or obligations either a financial or legal nature incurred by the other party to this Agreement.

(B)Both parties agree to make a concerted effort to transfer patients as soon as practicable, when the need for transfer has been determined by the attending physician, regardless of race, creed, color, national origin, sex, or handicap. Policies pertaining to priority of admission and procedures for carrying out transfer of patients, including policies for the transportation of the patient, medical record date and personal effects will be developed and followed by the parties.

(C)______agrees to grant priority for suitable accommodations to patients of the ______when it is determined by the attending physician that said patients are in need of care in a long-term care facility; providing, however, that all conditions of eligibility for admission are met. The ______agrees to provide necessary in-patient hospital services when suitable accommodations are available for those residents of ______when such hospitalization is deemed necessary by the patient’s attending physician. It is understood and agreed the ______hospital will, to the extent possible, grant residents of ______a priority bed availability; providing, however, that all conditions of eligibility for admission are met. This also includes outpatient laboratory and x-ray facilities.

(D)This Agreement shall be effective from the date of signature and shall continue indefinitely, except that either party may withdraw by giving (30) thirty days notice in writing to the other party of its intentions to withdraw from this Agreement, whereupon withdrawal shall be effective at the expiration of the period contained in said notice. However, if either shall have its license revoked or suspended or otherwise fail to be licensed by the appropriate state agency, this Agreement shall terminate on the date when the loss of license occurs.

(E)This Agreement may be modified or amended by the mutual agreement of the parties, however, any such modification or amendment shall by attached to and become part of the agreement. This Agreement has been approved and accepted by resolution of the governing body of the:

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EXECUTIVE DIRECTOR DATE

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ADMINISTRATOR

HOSPITAL ADMINISTRATORDATE