Affiliation Agreements

In August 2012, Assistant Attorney General Erica Sumioka provided the Schools with a memo regarding her office’s approach to the review of Affiliation Agreements (attached above). As Health Sciences Administration (HSA) continues to understand and refine procedures in support of the Health Sciences Schools, we request the following when presenting Affiliation Agreements for Dave Anderson’s review and signature:

Agreements with no changes to the language in the AGO approved standard template and/or the AAG has already signed the document:

  • Attach a cover page that indicates it is the approved standard template
  • Note the person and preferred delivery method for return of the signed agreement (HSA will always send a scanned copy in addition to returning the original to the School). Agreements can be dropped off and picked up at C414-k
  • Plan on 3 business days for HSA review, signature and return

Agreements with changes to the standard template and/or Training Site generated templates:

  • Route to Alice Becker, AAG, and copy Lansing Jones, paralegal, for review and signature prior to requesting Dave Anderson’s signature
  • Note: please plan for up to 30 days to complete review at the AAG level
  • Route to Dave Anderson for signature

Attorney General Approved Template for School of Dentistry

Attorney General Approved Template for School of Pharmacy

Attorney General Approved Template for School of Public Health

Attorney General Approved Template for School of Nursing

Attorney General Approved Template for School of Social Work

Alternate AG Approved Blood Borne Pathogen Language:

32. School certifies that it has trained each student it sends to Training Site in universal precautions and transmission of blood-borne pathogens, and that it will send to Training Site only students who have been trained in and have practiced using universal precautions. School has provided the opportunity to receive Hepatitis B (HBV) vaccine to all clinical education program students before assignment to Training Site. Training Site will provide personal protection equipment that is appropriate for the tasks assigned to School’s students.

33. If a student sustains a needle-stick injury or other substantial exposure to bodily fluids of another or other potentially infectious material while participating in the clinical education program at Training Site, Training Site agrees to provide the following services or, if Training Site does not have the resources to provide such services, refer the student to the nearest emergency facility:

  • Being seen by Training Site’s employee health service and/or emergency department as soon as possible after the injury;
  • Emergency medical care following the injury;
  • Initiation of HBV, Hepatitis C (HCV) and HIV protocol;
  • HIV counseling and appropriate testing.

The student will be responsible for the costs of any such care, testing, and counseling.

34. If Training Site has the resources to provide the above services, the source patient’s HBV, HCV, and HIV status will be determined by Training Site in the usual manner to the extent possible.