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Product Detail
| AHLA's Guide To Healthcare Legal Forms, Agreements, And Policies, First Edition with CD-ROM (Non-Members) |
| American Health Lawyers Association |
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| Price: |
$299.00 |
| Publisher: |
AHLA |
| Format: |
Loosleaf with CD-ROM and 2009 Supplement |
| ISBN: |
9781422443149
10/2009 |
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| Description |
Table of Contents »TABLE OF CONTENTS
Business Transactions
ANTITRUST COMPLIANCE GUIDELINES
CLINICAL TRIAL AGREEMENT
CONTRACT TERM SHEET
FDA REGULATORY DUE DILIGENCE DRUG MANUFACTURER
DOCUMENT/INFORMATION REQUEST
FDA REGULATORY DUE DILIGENCE DRUG MANUFACTURER ISSUE CHECKLIST
GRANT ASSESSMENTS AUDIT PLAN
HOSPITAL-PHYSICIAN GROUP COVERAGE AGREEMENT
HOSPITALS SERVICE AGREEMENT
INITIAL DUE DILIGENCE REQUEST AND TRANSACTION EVALUATION FOR HEALTH CENTERS
INTEGRATED MEDICAL GROUP BUSINESS PLAN
INTEGRATED MEDICAL GROUP PROFESSIONAL LIMITED LIABILITY COMPANY
MANAGED CARE PLAN SAMPLE CLAUSES
MANAGEMENT SERVICES AND OFFICE SHARING AGREEMENT
MEDICAL DIRECTOR/HOSPITAL AGREEMENT
MEDICAL OFFICE LEASE AGREEMENT
NON-DISCLOSURE AGREEMENT
PROFESSIONAL SERVICES AGREEMENT BETWEEN A MEDICAL CENTER AND PHYSICIAN
SELECTED PROVISIONS FOR CONSULTING ENGAGEMENT LETTERS
SHARED RESEARCH SERVICES ARRANGEMENT CHECKLIST
Fraud and Abuse
COMPLIANCE PLAN EFFECTIVENESS SCORECARD
COMPLIANCE POLICY AND PLAN FOR AMBULATORY SURGERY CENTER
CORPORATE INTEGRITY AND CONSENT DECREES / SUMMARY OF REQUIREMENTS CHART
DOCUMENT RETENTION MEMORANDUM FOR INTERNAL INVESTIGATION
FILE MEMO RE: COMPLIANCE HOTLINE RESPONSE
HEALTHCARE COMPLIANCE QUESTIONNAIRE
IDN COMPLIANCE PROGRAM POLICY
INTERNAL INVESTIGATION DELEGATION OF AUTHORITY
INVESTIGATIVE WORK PLAN CONSIDERATIONS CHECKLIST
MEMORANDUM OF UNDERSTANDING WITH U.S. DEPARTMENT OF JUSTICE
NON-MONETARY PHYSICIAN GIFT BENEFIT AND BUSINESS MEAL TRACKING FORM
OIG ADVISORY OPINION EXEMPLAR REQUEST
PHYSICIAN SUBSIDY RECRUITMENT FORM
SUBPOENA FOR INTERNAL INVESTIGATION
Governance
AMBULATORY SURGERY CENTER AGREEMENT WITH 501(C)(3)
BOARD COMPENSATION VALUE WORKSHEET
COMPENSATION COMMITTEE CHARTER
COMPENSATION PHILOSOPHY
COMPENSATION RESOLUTIONS RELATING TO EXECUTIVE COMPENSATION
CONFIDENTIALITY POLICY FOR BOARD OF DIRECTORS
CONFLICT OF INTEREST STATEMENT TRUSTEE-OFFICER-EMPLOYEE
CORPORATE RESPONSIBILITY “SCORE CARD” FOR SYSTEM
DISQUALIFIED PERSON WORKSHEET
GUIDE SHEET FOR PROCESSING HEALTH CARE PROVIDER IRC 501(C)(3) EXEMPTION APPLICATIONS
MEDICAL STAFF APPOINTMENT RESTRICTIONS
MODEL CONFLICT OF INTEREST POLICY FOR MEDICAL STAFF
MODEL CONFLICT OF INTEREST POLICY FOR OFFICERS AND DIRECTORS
MODEL CONFLICT OF INTEREST POLICY FOR PHYSICIANS
NOTIFICATION OF REVOCATION OF MEDICAL STAFF MEMBERSHIP OR DENIAL OF APPOINTMENT TO MEDICAL STAFF BASED ON CONFLICT OF INTEREST CRITERIA
POLICY REGARDING CONFLICTS OF INTEREST—BOARD
POLICY REGARDING CONFLICTS OF INTEREST
SARBANES-OXLEY IMPLEMENTATION RECOMMENDATIONS
SARBANES-OXLEY NOTICE TO OUTSIDE COUNSEL
Health Information Technology
AMENDMENT TO BUSINESS ASSOCIATE AGREEMENT
AUTHORIZATION FOR RELEASE OF INDIVIDUALLY IDENTIFIED HEALTH INFORMATION
BUSINESS ASSOCIATE AGREEMENT LETTER
BUSINESS ASSOCIATE CONTRACT
CHECKLIST FOR ELECTRONIC HEALTH RECORDS ITEM OR SERVICE DONATIONS
CONFIDENTIALITY AGREEMENT FOR DISCLOSURES TO THIRD PARTIES
DISCLOSURE ACCOUNTING DOCUMENTATION FORM
ELECTRONIC COMMUNICATIONS POLICY
ELECTRONIC HEALTH RECORDS ACCESS AGREEMENTS CHECKLIST
ELECTRONIC TRADING PARTNER AGREEMENT
HIPAA APPLICATION TO SHADOW WORKFORCE MEMBER
HIPAA AUTHORIZATION FORMS FOR CLINICAL RESEARCH INVOLVING
SERUM/TISSUE BANKING
HIPAA TRANSACTIONS AGREEMENT TERMS AND CONDITIONS
IP AND TECHNOLOGY TRANSFER POLICY FOR FACULTY
LAW ENFORCEMENT OFFICER REQUEST FOR HEALTH INFORMATION RECORDS
PATIENT AUTHORIZATION TO DISCLOSE PHI TO LAW ENFORCEMENT AGENCY
PRIVACY COMPLAINT FORM
PRIVACY COMPLAINT MONTHLY LOG
PRIVACY OF HEALTH INFORMATION—POLICY AND PROCEDURE
PRIVACY OFFICER JOB DESCRIPTION
SECURITY REGULATION REQUIREMENTS
Labor and Employment
AGREEMENT TO SUBMIT TO RANDOM DRUG AND ALCOHOL TESTING AND REQUIRED COUNSELING
AMENDMENT TO PHYSICIAN EMPLOYMENT AGREEMENT
DRUG TESTING POLICY
E-MAIL USAGE POLICY FOR HEALTHCARE ORGANIZATIONS
EMPLOYMENT AGREEMENT SAMPLE PROVISIONS
IMMIGRATION INFORMATION SHEET
PROFESSIONAL ADMINISTRATIVE SERVICES EMPLOYMENT AGREEMENT
TELECOMMUTING AGREEMENT
TOTAL COMPENSATION TALLY SHEET
WHISTLEBLOWER EMPLOYEE HANDBOOK LANGUAGE
Long Term Care
ANCILLARY SERVICES AGREEMENT/ACUTE CARE HOSPITAL
ASSISTED LIVING DISCLOSURE STATEMENT (TEXAS)
CERTIFICATION AND RECERTIFICATION OF PATIENT ADMISSION—SKILLED NURSING FACILITY
DOCUMENT REQUEST CHECKLIST
DRAFT ENGAGEMENT LETTER FOR EXPERT WITNESS
EVACUATION TRANSFER FORM
LONG TERM CARE FACILITY LEASE AGREEMENT
MEDICAL DIRECTOR/ADVISOR SERVICES TIME SHEET
NURSING HOME EMERGENCY OPERATIONS PLAN (LOUISIANA)
NURSING HOME RESIDENT CENSUS FOR DISASTER EVACUATION PLANNING
PHARMACY SERVICES AGREEMENT
SKILLED NURSING FACILITY ADVANCE BENEFICIARY NOTICE
“UNDER ARRANGEMENT” AGREEMENT BETWEEN SNF AND SUPPLIER SAMPLE AGREEMENT
VOLUNTARY WAIVER OF MEDICARE BENEFITS
Operations and Risk Management
AGREEMENT FOR PROFESSIONAL LEGAL SERVICES
AMBULATORY SURGICAL CENTER LICENSE AND REGISTRATION CHECKLIST
ARBITRATION AGREEMENT (SEPARATE FROM THE ADMISSION AGREEMENT)
ARBITRATION CLAUSE FOR INSERTION INTO ADMISSION AGREEMENT
CLINIC CERTIFICATION AND LICENSE CHECKLIST
CONTRACT REVIEW AND EXECUTION POLICY
DISCLOSURE AND APOLOGY WORKBOOK
DISCOVERY OF ALCOHOL, CHEMICAL SUBSTANCES OR WEAPONS IN PATIENT’S POSSESSION / POLICY
DOCUMENT RETENTION MEMORANDUM FOR INTERNAL INVESTIGATION
EVIDENCE OF COMMUNITY NEED CHECKLIST
HEALTH SYSTEM RISK MANAGEMENT PLAN
HOSPITAL LICENSING CHECKLIST
IN-HOUSE COUNSEL LEGAL SUBJECT MATTER STAFFING CHART
IN-HOUSE COUNSEL QUALITY AUDIT CHECKLIST
INSURANCE COVERAGE ANALYSIS FOR PATIENTS ENROLLED IN A CLINICAL TRIAL
MEDICAL DEVICE EVALUATION COMMITTEE / PROCEDURES FOR COMMITTEE
INDEPENDENCE AND CONFLICTS OF INTEREST
VENDOR VISITATION AND INTERACTION POLICY
POLICY ON POLICIES
PROFESSIONAL MANAGEMENT DIVISION POLICIES AND PROCEDURES CHECKLIST
PROVIDER SERVICES AND LICENSE AGREEMENT
SURGERY CENTER CODE OF CONDUCT
UNANTICIPATED OUTCOME POLICY
Patient Care
ADMINISTRATION OF MEDICATIONS SAMPLE POLICY
BEHAVIOR MANAGEMENT AND ANTIPSYCHOTIC MEDICATION PRESCRIBING—CHECKLIST
CHECKLIST FOR THE OPERATION ROOM
CHEST PAIN EVALUATION—CLINICAL DOCUMENTATION GUIDELINE
CONSENT FOR INTERNAL USE OF PATIENT INFORMATION
CONSENT FOR SUBSTANCE ABUSE TESTING
CONSENT FOR TREATMENT
EMTALA COMPLIANCE CHECKLIST
INFORMED CONSENT TO PARTICIPATE IN RESEARCH
LETTER TO TERMINATE PHYSICIAN-PATIENT RELATIONSHIP
PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT
TRANSFERABLE PHYSICIAN ORDER FOR LIFE-SUSTAINING TREATMENT POLICY
REQUEST FOR CRIME-VICTIM RECORDS (OTHER THAN CHILD-ABUSE VICTIMS)
REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER / FORM
WITHDRAWING AND WITHHOLDING OF LIFE-SUSTAINING TREATMENT POLICY
Physicians
ANNOTATED SAMPLE PROVISIONS IN MEDICAL STAFF BYLAWS
CITIZENSHIP CRITERIA POLICY—INSTITUTIONAL CITIZENSHIP
CLINICAL TRAINING AGREEMENT
CREDENTIALS POLICY
DEFERRED COMPENSATION AGREEMENT
FITNESS FOR DUTY—CLINICAL AGREEMENT
FITNESS FOR DUTY—INTERVIEW DOCUMENTATION
FITNESS FOR DUTY—POLICY
FITNESS FOR DUTY—RETURN TO WORK AGREEMENT
HEARING OFFICER ENGAGEMENT LETTER
HEARING OFFICER INTRODUCTORY LETTER TO LEGAL COUNSEL FOR PARTIES
TO MEDICAL STAFF HEARING
HEARING OFFICER INTRODUCTORY STATEMENT TO HEARING COMMITTEE AND PARTIES
IMPAIRED PRACTITIONER POLICY
MEDICAL DIRECTOR JOB DESCRIPTION
MEDICAL DIRECTOR AND ON-CALL AGREEMENT
MEDICAL STAFF APPOINTMENT BYLAWS
MONTHLY TIME ALLOCATION STUDY
PHYSICIAN CONTRACT CHECKLIST
PHYSICIAN CONTRACT REVIEW MEMO
PHYSICIAN INCOME GUARANTEE MONTHLY REPORT
PHYSICIAN PAY PERIOD CHART
PHYSICIAN RECRUITMENT AGREEMENT
PHYSICIAN RECRUITMENT COMPENSATION CHECKLIST
PHYSICIAN SUPERVISION AGREEMENT FOR AN IDTF
POTENTIAL PHYSICIAN SUBSIDY RECRUITMENT FORM
Reimbursement
BILLING FOR INVESTIGATIONAL DEVICES AND DRUGS POLICY
CERTIFICATION OF FINANCIAL STATEMENTS
CHARITY CARE POLICY AND APPLICATION GUIDELINES
CLINICAL TRIAL COVERAGE CHART
COLLECTIONS POLICY
CONDITIONS OF ADMISSION FINANCIAL RESPONSIBILITY AND PRIVACY NOTICE
CONTINUED STAY LETTER
DISCOUNT FOR UNINSURED PATIENTS POLICY
ELIGIBILITY FOR PROVIDER-BASED STATUS CHECKLIST
HEALTH SYSTEM CHARITY CARE AND TABLE OF CONTENTS
Business Transactions
ANTITRUST COMPLIANCE GUIDELINES
CLINICAL TRIAL AGREEMENT
CLOSING CHECKLIST
CONTRACT TERM SHEET
FDA REGULATORY DUE DILIGENCE DRUG MANUFACTURER
DOCUMENT/INFORMATION REQUEST
FDA REGULATORY DUE DILIGENCE DRUG MANUFACTURER ISSUE CHECKLIST
GRANT ASSESSMENTS AUDIT PLAN
HOSPITAL-PHYSICIAN GROUP COVERAGE AGREEMENT
HOSPITALS SERVICE AGREEMENT
INITIAL DUE DILIGENCE REQUEST AND TRANSACTION EVALUATION FOR HEALTH CENTERS
INTEGRATED MEDICAL GROUP BUSINESS PLAN
INTEGRATED MEDICAL GROUP PROFESSIONAL LIMITED LIABILITY COMPANY
MANAGED CARE PLAN SAMPLE CLAUSES
MANAGEMENT SERVICES AND OFFICE SHARING AGREEMENT
MASTER SERVICE AND SUBLICENSE AGREEMENT
MATERIAL LICENSE AGREEMENT FOR USE WITH INDUSTRY
MEDICAL DIRECTOR/HOSPITAL AGREEMENT
MEDICAL OFFICE LEASE AGREEMENT
NON-DISCLOSURE AGREEMENT
PROFESSIONAL SERVICES AGREEMENT BETWEEN A MEDICAL CENTER AND PHYSICIAN
SELECTED PROVISIONS FOR CONSULTING ENGAGEMENT LETTERS
SHARED RESEARCH SERVICES ARRANGEMENT CHECKLIST
Fraud and Abuse
APPOINTMENT OF APPROPRIATE SENIOR PERSONNEL TO OVERSEE THE CORPORATE RESPONSIBILITY PROGRAM (CRP) POLICY
COMPLIANCE PLAN EFFECTIVENESS SCORECARD
COMPLIANCE POLICY AND PLAN FOR AMBULATORY SURGERY CENTER
CORPORATE INTEGRITY AND CONSENT DECREES / SUMMARY OF REQUIREMENTS CHART
DISCLOSURE FORM FOR PHYSICIAN OR PHYSICIAN FAMILY MEMBER FINANCIAL RELATIONSHIP WITH HOSPITAL
DOCUMENT RETENTION MEMORANDUM FOR INTERNAL INVESTIGATION
EFFECTIVE RESPONSES TO THREAT OF WHISTLEBLOWERS' CLAIMS CHECKLIST
FILE MEMO RE: COMPLIANCE HOTLINE RESPONSE
FINANCIAL RELATIONSHIP: HEALTHCARE OBJECTIVES ASSESSMENT
HEALTHCARE COMPLIANCE QUESTIONNAIRE
HOSPITAL/PHYSICIAN RELATIONSHIPS
HOW TO OPERATIONALIZE STARK
IDN COMPLIANCE PROGRAM POLICY
INTERNAL INVESTIGATION DELEGATION OF AUTHORITY
INTERNAL INVESTIGATIONS POLICY
INTERVIEW SCHEDULING SCRIPT
INVESTIGATION CLOSURE MEMO
INVESTIGATIVE WORK PLAN CONSIDERATIONS CHECKLIST
MEMORANDUM OF UNDERSTANDING WITH U.S. DEPARTMENT OF JUSTICE
MODEL CORPORATE RESPONSIBILITY PROGRAM (CRP) POLICY
NON-MONETARY PHYSICIAN GIFT BENEFIT AND BUSINESS MEAL TRACKING FORM
OFFICERS' CERTIFICATION
OIG ADVISORY OPINION EXEMPLAR REQUEST
PHYSICIAN SUBSIDY RECRUITMENT FORM
POLICY ON COOPERATION WITH REGULATORS AND INVESTIGATORS
POLICY ON DISCIPLINE FOR CORPORATE RESPONSIBILITY PROGRAM-RELATED INFRACTIONS
POLICY TO SUPPORT AND PROMOTE THE CRP AS AN EVALUATION FACTOR FOR SUPERVISORSAND MANAGERS
PROHIBITION ON EMPLOYING, CONTRACTING OR GRANTING PRIVILEGES TO EXCLUDED INDIVIDUALS AND ENTITIES: POLICY
SUBPOENA FOR INTERNAL INVESTIGATION
Governance
AMBULATORY SURGERY CENTER AGREEMENT WITH 501(C)(3)
BOARD COMPENSATION VALUE WORKSHEET
COMPENSATION COMMITTEE CHARTER
COMPENSATION PHILOSOPHY
COMPENSATION RESOLUTIONS RELATING TO EXECUTIVE COMPENSATION
CONFIDENTIALITY POLICY FOR BOARD OF DIRECTORS
CONFLICT OF INTEREST STATEMENT TRUSTEE-OFFICER-EMPLOYEE
CORPORATE RESPONSIBILITY “SCORE CARD” FOR SYSTEM
DISQUALIFIED PERSON WORKSHEET
GUIDE SHEET FOR PROCESSING HEALTH CARE PROVIDER IRC 501(C)(3) EXEMPTION APPLICATIONS
MEDICAL STAFF APPOINTMENT RESTRICTIONS
MODEL CONFLICT OF INTEREST POLICY FOR MEDICAL STAFF
MODEL CONFLICT OF INTEREST POLICY FOR OFFICERS AND DIRECTORS
MODEL CONFLICT OF INTEREST POLICY FOR PHYSICIANS
NOTIFICATION OF REVOCATION OF MEDICAL STAFF MEMBERSHIP OR DENIAL OF APPOINTMENT TO MEDICAL STAFF BASED ON CONFLICT OF INTEREST CRITERIA
POLICY REGARDING CONFLICTS OF INTEREST—BOARD
POLICY REGARDING CONFLICTS OF INTEREST
SARBANES-OXLEY IMPLEMENTATION RECOMMENDATIONS
SARBANES-OXLEY NOTICE TO OUTSIDE COUNSEL
TAX COMPLIANCE OBJECTIVES
Health Information Technology
AMENDMENT TO BUSINESS ASSOCIATE AGREEMENT
AUTHORIZATION FOR RELEASE OF INDIVIDUALLY IDENTIFIED HEALTH INFORMATION
BUSINESS ASSOCIATE AGREEMENT LETTER
BUSINESS ASSOCIATE CONTRACT
CHECKLIST FOR ELECTRONIC HEALTH RECORDS ITEM OR SERVICE DONATIONS
CONFIDENTIALITY AGREEMENT FOR DISCLOSURES TO THIRD PARTIES
DATA USE AGREEMENT
DISCLOSURE ACCOUNTING DOCUMENTATION FORM
ELECTRONIC COMMUNICATIONS POLICY
ELECTRONIC HEALTH RECORDS ACCESS AGREEMENTS CHECKLIST
ELECTRONIC TRADING PARTNER AGREEMENT
HIPAA APPLICATION TO SHADOW WORKFORCE MEMBER
HIPAA AUTHORIZATION FORMS FOR CLINICAL RESEARCH INVOLVING
SERUM/TISSUE BANKING
HIPAA TRANSACTIONS AGREEMENT TERMS AND CONDITIONS
IP AND TECHNOLOGY TRANSFER POLICY FOR FACULTY
LAW ENFORCEMENT OFFICER REQUEST FOR HEALTH INFORMATION RECORDS
PATIENT AUTHORIZATION TO DISCLOSE PHI TO LAW ENFORCEMENT AGENCY
PRIVACY COMPLAINT FORM
PRIVACY COMPLAINT MONTHLY LOG
PRIVACY OF HEALTH INFORMATION—POLICY AND PROCEDURE
PRIVACY OFFICER JOB DESCRIPTION
RECORDS MANAGEMENT/RETENTION GUIDELINES
SECURITY REGULATION REQUIREMENTS
Labor and Employment
AGREEMENT TO SUBMIT TO RANDOM DRUG AND ALCOHOL TESTING AND REQUIRED COUNSELING
AMENDMENT TO PHYSICIAN EMPLOYMENT AGREEMENT
DRUG TESTING POLICY
E-MAIL USAGE POLICY FOR HEALTHCARE ORGANIZATIONS
EMPLOYEE RELOCATION AGREEMENT
EMPLOYMENT AGREEMENT SAMPLE PROVISIONS
EXIT INTERVIEWS POLICY
IMMIGRATION INFORMATION SHEET
PROFESSIONAL ADMINISTRATIVE SERVICES EMPLOYMENT AGREEMENT
TELECOMMUTING AGREEMENT
TOTAL COMPENSATION TALLY SHEET
WHISTLEBLOWER EMPLOYEE HANDBOOK LANGUAGE
Long Term Care
ANCILLARY SERVICES AGREEMENT/ACUTE CARE HOSPITAL
ASSISTED LIVING DISCLOSURE STATEMENT (TEXAS)
CERTIFICATION AND RECERTIFICATION OF PATIENT ADMISSION—SKILLED NURSING FACILITY
DOCUMENT REQUEST CHECKLIST
DRAFT ENGAGEMENT LETTER FOR EXPERT WITNESS
EVACUATION TRANSFER FORM
LONG TERM CARE FACILITY LEASE AGREEMENT
MEDICAL DIRECTOR/ADVISOR SERVICES TIME SHEET
NURSING HOME EMERGENCY OPERATIONS PLAN (LOUISIANA)
NURSING HOME RESIDENT CENSUS FOR DISASTER EVACUATION PLANNING
PHARMACY SERVICES AGREEMENT
SKILLED NURSING FACILITY ADVANCE BENEFICIARY NOTICE
“UNDER ARRANGEMENT” AGREEMENT BETWEEN SNF AND SUPPLIER SAMPLE AGREEMENT
VOLUNTARY WAIVER OF MEDICARE BENEFITS
Operations and Risk Management
AGREEMENT FOR PROFESSIONAL LEGAL SERVICES
AMBULATORY SURGICAL CENTER LICENSE AND REGISTRATION CHECKLIST
ARBITRATION AGREEMENT (SEPARATE FROM THE ADMISSION AGREEMENT)
ARBITRATION CLAUSE FOR INSERTION INTO ADMISSION AGREEMENT
CLINIC CERTIFICATION AND LICENSE CHECKLIST
CONTRACT REVIEW AND EXECUTION POLICY
DEVELOPMENT OF A PHYSICIAN ENTERPRISE MODEL (PEM) CHECKLIST
DISCLOSURE AND APOLOGY WORKBOOK
DISCOVERY OF ALCOHOL, CHEMICAL SUBSTANCES OR WEAPONS IN PATIENT’S POSSESSION / POLICY
DOCUMENT RETENTION MEMORANDUM FOR INTERNAL INVESTIGATION
EVIDENCE OF COMMUNITY NEED CHECKLIST
HEALTH SYSTEM RISK MANAGEMENT PLAN
HOSPITAL LICENSING CHECKLIST
IN-HOUSE COUNSEL LEGAL SUBJECT MATTER STAFFING CHART
IN-HOUSE COUNSEL QUALITY AUDIT CHECKLIST
INSURANCE COVERAGE ANALYSIS FOR PATIENTS ENROLLED IN A CLINICAL TRIAL
EMAIL FOR INVESTIGATION MEMO
MEDICAL DEVICE EVALUATION COMMITTEE / PROCEDURES FOR COMMITTEE
INDEPENDENCE AND CONFLICTS OF INTEREST
NON-DISCLOSURE AGREEMENT
VENDOR VISITATION AND INTERACTION POLICY
POLICY ON POLICIES
POLICY FOR THE RECRUITMENT OF SUBJECTS
PROFESSIONAL MANAGEMENT DIVISION POLICIES AND PROCEDURES CHECKLIST
PROVIDER SERVICES AND LICENSE AGREEMENT
SURGERY CENTER CODE OF CONDUCT
TRACKING FOR INCIDENTAL BENEFITS AND NON-MONETARY COMPENSATION
UNANTICIPATED OUTCOME POLICY
Patient Care
ADMINISTRATION OF MEDICATIONS SAMPLE POLICY
BEHAVIOR MANAGEMENT AND ANTIPSYCHOTIC MEDICATION PRESCRIBING—CHECKLIST
CHECKLIST FOR THE OPERATION ROOM
CHEST PAIN EVALUATION—CLINICAL DOCUMENTATION GUIDELINE
CONSENT FOR INTERNAL USE OF PATIENT INFORMATION
CONSENT FOR SUBSTANCE ABUSE TESTING
CONSENT FOR TREATMENT
EMTALA COMPLIANCE CHECKLIST
EXEMPT RESEARCH CHECKLIST
EXEMPT RESEARCH STATEMENT
INFORMED CONSENT FOR OFF-LABEL USE OF A DRUG OR DEVICE
INFORMED CONSENT TO PARTICIPATE IN RESEARCH
LETTER TO TERMINATE PHYSICIAN-PATIENT RELATIONSHIP
PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT
TRANSFERABLE PHYSICIAN ORDER FOR LIFE-SUSTAINING TREATMENT POLICY
REQUEST FOR CRIME-VICTIM RECORDS (OTHER THAN CHILD-ABUSE VICTIMS)
REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER / FORM
WITHDRAWING AND WITHHOLDING OF LIFE-SUSTAINING TREATMENT POLICY
Physicians
ANNOTATED SAMPLE PROVISIONS IN MEDICAL STAFF BYLAWS
CITIZENSHIP CRITERIA POLICY—INSTITUTIONAL CITIZENSHIP
CLINICAL TRAINING AGREEMENT
CONTRACT LEGAL REVIEW CERTIFICATION FORM
CREDENTIALS POLICY
DEFERRED COMPENSATION AGREEMENT
FAIR HEARING AND APPELLATE REVIEW PLAN
FITNESS FOR DUTY—CLINICAL AGREEMENT
FITNESS FOR DUTY—INTERVIEW DOCUMENTATION
FITNESS FOR DUTY—POLICY
FITNESS FOR DUTY—RETURN TO WORK AGREEMENT
HEARING OFFICER ENGAGEMENT LETTER
HEARING OFFICER INTRODUCTORY LETTER TO LEGAL COUNSEL FOR PARTIES
TO MEDICAL STAFF HEARING
HEARING OFFICER INTRODUCTORY STATEMENT TO HEARING COMMITTEE AND PARTIES
IMPAIRED PRACTITIONER POLICY
LETTER TO PRACTITIONER REGARDING ADVERSE RECOMMENDATION AND RIGHT TO HEARING
MEDICAL DIRECTOR JOB DESCRIPTION
MEDICAL DIRECTOR AND ON-CALL AGREEMENT
MEDICAL STAFF APPOINTMENT BYLAWS
MONTHLY TIME ALLOCATION STUDY
PHYSICIAN CONTRACT CHECKLIST: RECRUITMENT, EMPLOYMENT, AND INDEPENDENT CONTRACTORS
PHYSICIAN CONTRACT REVIEW MEMO
PHYSICIAN CONTRACT CHECKLIST
PHYSICIAN CONTRACT REVIEW MEMO
PHYSICIAN INCOME GUARANTEE MONTHLY REPORT
PHYSICIAN PAY PERIOD CHART
PHYSICIAN RECRUITMENT AGREEMENT
PHYSICIAN RECRUITMENT COMPENSATION CHECKLIST
PHYSICIAN SUPERVISION AGREEMENT FOR AN IDTF
POTENTIAL PHYSICIAN SUBSIDY RECRUITMENT FORM
TIME STUDY REPORT
Reimbursement
BILLING FOR CLINICAL RESEARCH SERVICES ITEMS AND TESTS
BILLING FOR INVESTIGATIONAL DEVICES AND DRUGS POLICY
CERTIFICATION OF FINANCIAL STATEMENTS
CHARITY CARE POLICY AND APPLICATION GUIDELINES
CLINICAL TRIAL COVERAGE CHART
COLLECTIONS POLICY
CONDITIONS OF ADMISSION FINANCIAL RESPONSIBILITY AND PRIVACY NOTICE
CONTINUED STAY LETTER
DISCOUNT FOR UNINSURED PATIENTS POLICY
ELIGIBILITY FOR PROVIDER-BASED STATUS CHECKLIST
HEALTH SYSTEM CHARITY CARE AND FINANCIAL AID GUIDELINES
HOSPITAL-ISSUED NOTICE OF NON-COVERAGE
MEDICARE GRADUATE MEDICAL EDUCATION AFFILIATION AGREEMENT
MEDICARE PART D COVERAGE DETERMINIATION REQUEST FORM
MEMORANDUM OF UNDERSTANDING—SETTLEMENT AGREEMENT
OVERPAYMENTS AND RECOUPMENT SAMPLE CORRESPONDENCE
PROVIDER PARTICIPATION CONTRACTS AND/OR AGREEMENTS
RATIO OF COSTS TO CHARGES WORKSHEET
REBUTTABLE PRESUMPTION CHECKLIST
REQUEST FOR AMBULANCE TRANSPORTATION FOR A BENEFICIARY IN A MEDICARE PART A STAY
SNF’S NOTICE TO PHYSICIAN TREATING A BENEFICIARY IN MEDICARE PART A STAY
THIRD-PARTY BILLING & PROHIBITED BILLING PRACTICES POLICY
TRADITIONAL CHARITY CARE WORKSHEET
UNPAID COSTS OF MEDICAID AND OTHER PUBLIC PROGRAMS WORKSHEET
WEEKLY PART A BENEFICIARY SERVICE LOG
THIS BRAND NEW PUBLICATION IS A COMPREHENSIVE COLLECTION OF FORMS, AGREEMENTS, CONTRACTS, CHECKLISTS AND OTHER DOCUMENTS FREQUENTLY USED BY HEALTH LAW PRACTITIONERS.
Collected from expert health law attorneys and members of AHLA, this resource is designed to meet the needs of health law attorneys who must regularly create such documents for their clients.
Conveniently organized by topic in a looseleaf format, AHLA’s Guide to Healthcare Legal Forms, Agreements, and Policies contains more than 240 sample forms that you can use to prepare documents to meet your clients’ needs. The Guide contains documents pertaining to the following 10 topics:
Business Transactions
Fraud and Abuse
Governance
Health Information Technology
Labor and Employment
Long Term Care
Operations and Risk Management
Patient Care
Physicians
Reimbursement
Using The Guide:
The Guide comes with a companion CD-ROM which contains all the documents in an electronic .rtf format.
STEP 1:
Find the appropriate template from AHLA’s Guide to Healthcare Legal Forms, Agreements, and Policies;
STEP 2:
Pop the companion CD-ROM into your computer, and find the corresponding form;
STEP 3:
Adapt the appropriate form to your client’s needs.
Among the myriad forms in The Guide are samples of:Business Associate Agreement with HITECH Act Language* Billing Practices Compliance ObjectivesDocument Retention Memorandum for Internal InvestigationHospital-Physician Contractor Services AgreementDisclosure Form for Physician or Physician Family Member Financial Relationship with HospitalHow to Operationalize Stark ChecklistHealthcare Compliance QuestionnaireOIG Advisory Opinion Exemplar RequestModel Conflict of Interest Policy for Medical StaffHIPAA Marketing Authorization Form*Confidentiality Agreement for Disclosure to Third PartiesEmployment Agreement Sample ProvisionPolicy on Cooperation with Regulators and Investigators Risk Management Program Policies for Hospitals*Checklist for the Operating RoomEMTALA Compliance ChecklistDisruptive Practitioner Policy*Impaired Practitioner PolicyPhysician Recruitment Agreement"Never-Events"-Sample Contract Provisions*Development of a Physician Enterprise Model ChecklistProvider Participation Contracts and/or agreements, and many more!
*New form added in the 2009 Supplement
To purchase the 2009 Supplement, click here.
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