Page 72 - 2021 MHA Start-up Guide

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MEMORANDUM OF AGREEMENT BETWEEN
AGENCY 1
AND _______________
FOR USE OF PARKING AREA FOR MOBILE CLINIC OPERATIONS

This memorandum of agreement (the “Agreement”), effective on the date of last signature below (“Effective
Date”), by and between AGENCY1, for the benefit of the ---- (“AGENCY1”) and _______________________________

WITNESSETH:

WHEREAS, in furtherance of its mission of ------, AGENCY1, through its appropriately qualified physicians and
support personnel, provides a mobile platform (“Vehicle”) for healthcare and screening services at various locations
throughout ------- County, where such services are provided by AGENCY1;
WHEREAS, _________ is willing to offer the use of its parking area to AGENCY1 as a site for the mobile clinic
in order to benefit community members and residents of the surrounding areas; and

WHEREAS, AGENCY1 is willing to provide healthcare services at ___________’s facility on certain dates and
times, subject to its discretion and the availability of qualified volunteer providers.

NOW, THEREFORE, the parties mutually agree as follows:

PURPOSE

AGENCY1’s purpose or “mission” is to achieve ------. The provision of AGENCY1 mobile clinic services as
defined herein operates to further these important goals, by providing AGENCY1 the opportunity to provide and improve
availability of services to an underserved patient population, whereby enhanced opportunities are likely to develop for the
services programs of the AGENCY1.

1. This Agreement will take effect on the Effective Date and remain in effect for a period of one year
(“Agreement Term”), unless earlier terminated, or amended by written agreement of the parties.

2. ________________________ and AGENCY1 will discuss and agree upon a suitable area of the parking
lot/s at ________________________’s facility where the Vehicle can be parked for purposes of mobile clinic operations.
________________________ may allow AGENCY1 access to additional areas of the ________________________ facility
for mobile clinic-related purposes, i.e. storage, patient check-in and waiting etc., at its discretion.
3. ________________________All healthcare services rendered at the Vehicle will be provided by AGENCY1.
AGENCY1 personnel will wear badges identifying their status as employees or agents of AGENCY1 at all times.

4. AGENCY1, All liability protection described in this Section is on an “occurrence” basis. The
AGENCY1. (DESCRIPTION OF INSURANCE COVERAGES AND WAIVERS HERE)

5. The parties understand that there will be no payment by either of the parties to this Agreement to the
other. AGENCY1 will not charge patients for healthcare screening or services that may be provided by AGENCY1 at the
mobile clinic. No provider will be required to provide any healthcare service as a condition of this Agreement.

6. Any signage, advertising, or promotional material that uses the name, logo, or likeness of AGENCY1, or
any of AGENCY1’s staff, must be approved by AGENCY1 in advance. The spokesperson for AGENCY1 in this regard is
(CONTACT INFO)

7. Either party may terminate this Agreement with or without cause upon ten (10) days notice to the other
party.

8. Except as stated in Section 6 above, the representatives of the parties for purposes of this Agreement
shall be as follows:

7 0 MOBILE HEALTH CARE PROGRAM STAR T-UP GUIDE