Provider Service Agreement 

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  • This agreement ("Agreement") between Allied Staffing Network (“Allied Staffing Network”), a Texas Limited Liability Company and the above named provider (“Provider”) shall be effective as of the above listed date (“Effective Date”).

    WHEREAS; Allied Staffing Network contracts with third party healthcare facilities (“Client”) to arrange for medical services to be provided on a temporary basis; and,
    WHEREAS; Provider desires to provide medical services to Allied Staffing Network’s Clients on a temporary basis (“Assignment”); therefore,

    Payments and Expenses:

    1.1 Provider Rates: Allied Staffing Network will act as a staffing agency to facilitate the negotiation of hourly rates between Provider and Client and for each. Rates may include any of the following, but none are guaranteed on any given assignment, Daily Rate, Hourly Rate, Overtime, Call Back, Pager, Holiday, or others as agreed. Allied Staffing Network shall confirm all Rates in a confirmation letter sent to the Provider prior to an assignment beginning. Provider shall notify Allied Staffing Network, according to the timeline stated in the confirmation letter, of any perceived error in the rates in the confirmation letter. If no such notice is given by the Provider, the rate in the confirmation letter will be deemed accepted when the Provider starts the assignment.
    1.2 Timesheets: Provider will submit a timesheet, which has been signed by the Client, to Allied Staffing Network by the deadline stated in the confirmation letter. If the Provider submits a timesheet after the deadline for submission, Allied Staffing Network will issue the payment during the next regularly scheduled payroll cycle.
    1.3 Transportation:Allied Staffing Network will use its best efforts to ensure the Client provides round trip travel for each assignment, including local transportation for the duration of assignment. Allied Staffing Network shall not be obligated to reimburse for travel expenses which are not approved by Client prior to the Provider’s purchase, or that the Provider arranges other than through Allied Staffing Network.
    1.4 Housing: When required, and when not included in an all-inclusive rate, Allied Staffing Network will provide reasonable housing accommodations on behalf of Client while Provider is either on, or en route to an assignment, in accordance with the terms stated in the confirmation letter. Provider will be responsible for all personal expenses including but not limited to meals and incidental expenses. If an all-inclusive rate has been negotiated by Provider and Client, Provider and not Allied Staffing Network shall pay for housing.
    1.5 Release and Authorization: Provider shall review and sign Allied Staffing Network’s Release and Authorization which permits Allied Staffing Network to release any information required for privileges relating to an assignment, including potentially confidential and protected information. Allied Staffing Network will use good faith efforts to prevent any errors in reproduction, presentation, and disclosure of all such information. Provider shall release and hold Allied Staffing Network harmless from all liability for any such errors made without willful misconduct on the part of Allied Staffing Network, its Agents, Employees, or Clients.
    1.6 Hospital Privileges and Licensure: Provider agrees to provide accurate information in a timely manner to Allied Staffing Network and Client to complete required privileging and/or state licensure applications. Allied Staffing Network shall assist Provider in obtaining necessary documentation. As a part of hospital privileges, Provider may be required to submit to drug screening. Provider will not be required to pay for any costs relating to obtaining necessary privileges relating to an assignment.

    Provider Duties:

    2.1 Insurance: During the Term of this agreement, Allied Staffing Network shall facilitate at its expense, professional liability insurance for professional services rendered by the Provider under this agreement in the amount of at least $1,000,000 for each occurrence with a per annum aggregate limitation of $3,000,000 unless Provider is eligible and enrolled in a State Compensation fund that mandates lower limits of liability. Allied Staffing Network has secured and will continue to secure claims-made coverage and prior acts coverage. Allied Staffing Network will purchase tail coverage in the event of any lapse or cancellation of the policy. The insurance facilitated by Allied Staffing Network applies only to agreed-upon services provided by Provider during an Assignment. Allied Staffing Network will not facilitate liability insurance for these limits unless and until Provider has signed and returned this Agreement to Allied Staffing Network. Provider further acknowledges that Allied Staffing Network will not provide malpractice insurance coverage for any assignment that is not preapproved and arranged by Allied Staffing Network, including dates at a Client where the Provider has previously provided services for Allied Staffing Network.