PRACTICE SITE. All approved tasks may be performed for care of patients in this office or clinic located at and, in hospital(s) and (Address / City) (Address / City) skilled nursing facility (facilities) for care of (Name of Facility) patients admitted to those institutions by physician(s) . (Name/s))
PRACTICE SITE. Authorizing Practitioner must have a practice site either within the county in which Pharmacy is located or in an adjoining county.26
PRACTICE SITE. All approved tasks may be performed for care of patients at Xxxxxx Xxxxxx UCLA Medical Center and/or UCLA Santa Xxxxxx Hospital for care of patients admitted to those institutions by the medical staff member: (Name/s)) EMERGENCY TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at either Xxxxxx Xxxxxx UCLA Medical Center or UCLA Santa Xxxxxx Hospital is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician on staff. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at (Name of Medical Staff member) (Phone Number) immediately (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. Date Physician's Signature (Required) Physician's Printed Name Date Physician Assistant's Signature (Required) SUPERVISING PHYSICIAN'S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISOR , M.D./D.O. is licensed to practice in California as a physician and surgeon with medical license number . Hereinafter, the above named physician shall be referred to as the supervising physician.
PRACTICE SITE. All approved tasks as specified in the delineation of privileges may be performed for care of patients in this office or clinic located at and, in (office/clinic address)
PRACTICE SITE. All medical services consistent with this Practice Agreement and as specified in the Practice Prerogative Application Card (appended hereto) may be performed for care of patients in the Torrance Memorial Medical Center Emergency Department located at 0000 Xxxxxx Xxxx., Xxxxxxxx, XX 00000.
PRACTICE SITE. All approved tasks may be performed for care of patients in this office or clinic located at _________________________________________ and, in ______________________________ hospital(s) and (Address / City) (Address / City) ________________________________________________________ skilled nursing facility (facilities) for care of (Name of Facility) patients admitted to those institutions by physician(s) _________________________________________ . (Name/s))
PRACTICE SITE. All approved tasks may be performed for care of patients in this office or clinic located at and, in hospital(s) and (Address/City) (Address/City) skilled nursing facility (facilities) for care of (Name of Facility) patients admitted to those institutions by physician(s) (Name/s) EMERGENCY TRANSPORT AND BACKUP. In a medical emergency, telephone the 911 operator to summon an ambulance. The emergency room at (Name of Hospital) (Phone Number) is to be notified that a patient with an emergency problem is being transported to them for immediate admission. Give the name of the admitting physician. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Notify at immediately (Name of Physician) (Phone Number/s)) (or within minutes). PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. / Date Physician's Signature (Required) & Physician's Printed Name / Date Physician Assistant's Signature (Required) & Physician Assistant's Printed Name
PRACTICE SITE i. Manager shall provide to Physician, for his non-exclusive use in operating the Practice, the premises located at , together with all appurtenances, improvements and fixtures (collectively, the “Practice Site”). Changes in location of the Practice Site may be effected by Manager as of the expiration of any lease or other arrangement by which Manager leases or occupies the Practice Site or at any other time as may be approved in writing by Manager after consultation with Physician. Further, Manager shall have the exclusive right to manage Physician’s Practice at any additional location at which Physician provides medical services, and such additional locations shall be considered a “Practice Site” for purposes of this Agreement, and Physician’s performance of medical services at such additional Practice Site(s) shall be subject to the terms and conditions contained in this Agreement. Physician acknowledges that this Agreement and Manager’s provision of any Practice Site to Physician gives Physician only a conditional right to use the Practice Site, which right shall automatically expire, without notice or further action by Manager, upon the expiration or early termination of this Agreement for any reason, and Physician shall immediately vacate the Practice Site upon such expiration or early termination. Physician further acknowledges that no leasehold interest is created or conveyed by this Agreement, and that no landlord- Services will increase as the volume of Physician’s Practice increases. Manager and Physician acknowledge that the Fee, as such term is defined below, has resulted from arm’s length negotiations between the parties and does not take into account the volume or value of referrals or business otherwise generated between the parties, and is consistent with fair market value for the Services, including the Office Equipment, Medical Equipment and Practice Site provided by Manager to Physician. Accordingly, as compensation in full for the performance of the Services hereunder, Physician shall pay Manager a fee of forty-five percent (45%) of Physician’s Gross Revenues received during each calendar month during the term of this Agreement (the “Management Fee”). As used herein, the term “Gross Revenues” shall be defined to mean all amounts received by Physician relating to any and all professional services and ancillary services related to medical rendered by Physician and the Licensed Health Professionals to patients at the Practice Site, whethe...
PRACTICE SITE i. Manager shall provide to Physician, for his non-exclusive use in operating the Practice, the premises located at 0000 Xxxxxxxx Xxxxxxxxx, Xxxxx 000, Xxxxxxx Xxxxx, Xxxxxxxxxx 00000, together with all appurtenances, improvements and fixtures (collectively, the “Practice Site”). Changes in location of the Practice Site may be effected by Manager as of the expiration of any lease or other arrangement by which Manager leases or occupies the Practice Site or at any other time as may be approved in writing by Manager after consultation with Physician. Further, Manager shall have the exclusive right to manage Physician’s Practice at any additional location at which Physician provides tattoo removal services, and such additional locations shall be considered a “Practice Site” for purposes of this Agreement, and Physician’s performance of tattoo removal services at such additional Practice Site(s) shall be subject to the terms and conditions contained in this Agreement. Physician acknowledges that this Agreement and Manager’s provision of any Practice Site to Physician gives Physician only a conditional right to use the Practice Site, which right shall automatically expire, without notice or further action by Manager, upon the expiration or early termination of this Agreement for any reason, and Physician shall immediately vacate the Practice Site upon such expiration or early termination. Physician further acknowledges that no leasehold interest is created or conveyed by this Agreement, and that no landlord-tenant relationship is created by this Agreement or otherwise exists between Manager and Physician.
