HomeMy WebLinkAbout064472 - General - Contract - The University of Texas Southwestern Medical CenterUT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
PROGRAM LETTER AGREEMENT FOR GRADUATE MEDICAL EDUCATION
This Program Letter Agreement for Graduate Medical Education (Agreement ) is made and entered into to be
effective as of the last date of signature below, (Effective Date ) by and between The University of Texas
Southwestern Medical Center, an agency of the State of Texas and public institution of higher education located
at 5323 Harry Hines Blvd., Dallas, TX 75390 (Sponsoring Institution and City of Fort Worth, located at 100
Fort Worth Trail, Fort Worth, TX 76102 (). This Agreement sets forth the responsibilities of each party
Emergency
Medical Services Fellowship Program (Program ).
WHEREAS, Sponsoring Institution trains physicians in its Program (Trainees );
WHEREAS, Facility participates in the training of Trainees by providing residents and/or fellows in the Program
with a clinical educational experience utilizing appropriate facilities and personnel;
WHEREAS, the Accreditation Council for Graduate Medical Education (ACGME ) requires the Sponsoring
Institution to be responsible for the quality of all educational experience and to retain
activities;
WHEREAS, Sponsoring Institution previously executed a similar agreement with the Metropolitan Area EMS
Authority d/b/a MedStar Mobile Healthcare effective as of July 1, 2023, the same being UT
Southwestern Contract ID# FY2025-GME2-01
WHEREAS, effective June 30, 2025, MedStar, and with the consent of Sponsoring Institution, assigned the
MedStar agreement to Facility, as amended in the assigning documents;
WHEREAS, the MedStar Agreement, identified by Facility as City Secretary Contract No. 63567, the same being
UT Southwestern Contract ID #FY2025-GME2-01344.1-NP, was amended to expire June 30, 2026;
WHEREAS, the Parties desire to enter into this Agreement to supersede and replace the MedStar Agreement in its
entirety, ensuring continuity of the training program while updating the terms and conditions to reflect the current
arrangement between Sponsoring Institution and Facility; and
WHEREAS, this Agreement shall constitute the entire understanding between Facility and Sponsoring Institution
with respect to the subject matter hereof and shall terminate and replace any prior agreements, including the
MedStar Agreement, upon its effective date.
Now, therefore, for and in consideration of the mutual covenants and conditions herein contained, and for other
good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged by, the parties
hereby agree to the terms and conditions as follows:
I. DESIGNATED OFFICIALS
Supervising
Faculty Member
II. POLICIES AND PROCEDURES
A. Supervision of Trainees. Trainees will function under supervision of a designated Supervising Faculty
Member according to the defined goals and objectives of the Program provided in the attached Exhibit,
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
incorporated herein by reference, and as applicable accreditation standards require. The Supervising
Faculty Member will be solely responsible for direct clinical supervision of the Trainees and shall control
the details of the medical tasks performed by the Trainees in compliance with applicable accreditation
standards.
B.Compliance with Protocols. Both parties hereto agree that, to the extent applicable, Trainees will comply
with the policies and procedures of Sponsoring Institution. While on the premises of Facility, Trainees
will comply with the applicable policies and procedures of Facility. Due process procedures will be
followed by Sponsoring Institution.
C.Exclusive Control. Facility will retain the exclusive control of its premises, operations, and all aspects of
its patient services, other than the practice of medicine by the faculty and Trainees.
III. RESPONSIBILITIES
In order to accomplish the goals and objectives of the Program provided in the attached Exhibit and according to
the policies and procedures described in Article II above, the parties agree as follows:
A. Sponsoring Institution agrees to:
1.Plan, implement, and administer the curriculum of the Program.
2. Program Director
and Facility and to coordinate the academic and clinical experience of Trainees. The Program Director
will have ultimate responsibility and final authority for the educational content of the Program and the
assignment of Trainees.
3.Contact the Facility at reasonable intervals to evaluate the Trainees and to determine if the Facility is
fulfilling its obligation to the Trainees.
4.Provide an appropriate instrument(s) for evaluation of the clinical experience (Evaluation Forms ).
5.Maintain in force during the term of this Agreement for any incidents occurring during the term of this
Agreement professional medical liability coverage for Trainees in an amount of $500,000 per
occurrence and $1,500,000 aggregate, pursuant to The University of Texas System Professional
Medical Liability Benefit Plan and under authority of Section 59.01, Texas Education Code.
6.To the extent authorized by the Constitution and the laws of the State of Texas, indemnify and hold
harmless Facility, its directors, officers, agents, and employees against any and all claims, demands,
damages, liabilities, and costs incurred by Facility which directly or indirectly result from, or arise in
connection with, any negligent acts or omissions of Sponsoring Institution, its Trainees, faculty,
B. Facility agrees to:
1.Designate one member of its medical staff as the Supervising Faculty Member who will assume
administrative, educational, and supervisory responsibility for the Trainees in the Program while at
the Facility. The Supervising Faculty Member for the Program will complete the Evaluation Form at
the conclusion of the rotation for each Trainee and provide such Evaluation Form to Sponsoring
Institution.
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
2.Provide opportunities for direct patient care and specified clinical experiences under appropriate
physician supervision and in areas where Trainees are assigned. Provide for graduated responsibility
for patient care by Trainees in clinical areas.
3.Obtain and maintain all licenses required for Facility and assure that all Facility personnel are
appropriately licensed. Provide sufficient staff and related resources necessary to implement the
clinical learning experiences of the Trainees.
4.Assist the Program Director in coordination of (a) orientation of the Trainees to the Facility; (b)
planning of clinical and learning experiences; and (c) orientation of and supervision by faculty at the
Facility.
5.Maintain in force during the term of this Agreement, and provide proof of such upon reasonable
request, general liability insurance. Alternatively, Facility may, at its discretion, elect to self-insure
provided that such self-insurance meets applicable statutory requirements set forth by state law,
including but not limited to chapter 2259 of the Texas Government Code.
6.To the extent authorized by the Constitution and the laws of the State of Texas, indemnify and hold
harmless The University of Texas System Board of Regents, Sponsoring Institution, its Trainees,
directors, officers, agents, and employees against any and all claims, demands, damages, liabilities,
and costs incurred by Sponsoring Institution which directly or indirectly result from, or arise in
connection with, the negligent acts or omissions of Facility, its Supervising Faculty Member or other
faculty, agen
C. Sponsoring Institution and Facility shall mutually agree to:
1.Identify the number of Trainees assigned to the Facility for clinical rotations and the dates of
assignment of Trainees for clinical rotations.
2.Inform each other of changes in personnel actively involved in the Program.
3.Decide to discontinue the clinical rotation term of a Trainee for good cause following consultation
between appropriate representatives of both parties, including the Program Director and Supervising
Faculty Member.
IV. DURATION OF GRADUATE MEDICAL EDUCATIONAL EXPERIENCE
A. Duration of Rotation. Duration of the
subject to the terms and conditions set forth below in Article IV.B.
B. Term and Termination. This Agreement shall become effective on the Effective Date and continue until
June 30, 2030, unless terminated earlier by either party in accordance with this Article IV.B.
1. Termination without Cause. Either party upon ninety (90) days advance written notice to the non-
terminating party may terminate this Agreement without cause. If such notice is given, this
Agreement shall terminate either (a) at the end of such ninety (90) days; or (b) after all Trainees
assigned to a rotation at the time such notice is given have completed their respective rotations,
whichever event occurs last.
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
2. Termination for Default. Either party may terminate this Agreement effective immediately and
without penalty if and when it determines, in its sole discretion and judgement, that the other party
is not complying with terms of this Agreement.
3. Automatic Termination. In the event that either party enters bankruptcy, takes an assignment for
the benefit of creditors, becomes subject to receivership, or is otherwise reasonably deemed
insolvent, then this Agreement shall terminate at the option of the other party.
V.MISCELLANEOUS
A.Privacy and Security Obligations. The parties acknowledge, understand, and agree that this Agreement
may be subject to (1) obligations and other regulations implementing the Health Insurance Portability and
Accountability Act of 1996 (HIPAA ), the administrative regulations and/or guidance which has been
issued or may in the future be issued pursuant to HIPAA, including but not limited to federal regulations
relating to the confidentiality, integrity, and accessibility of individually identifiable health information
(whether created, maintained, accessed, stored or transmitted electronically or otherwise) requiring
covered entities to comply with the privacy and security standards adopted by the U.S. Department of
Health and Human Services, 45 C.F.R. parts 160 and 164, subparts A and E (Privacy Rule ) and 45
C.F.R. parts 160, 162, and 164 subpart C (Security Rule ), and Texas state laws pertaining to medical
privacy (collectively, Privacy Laws ) and (2) the requirements of the Health Information Technology
for Economic and Clinical Health Act of 2009 (HITECH Act ).
B.Compliance with Privacy and Security Obligations. The Privacy and Security Rules require covered
entities to ensure that business associates who receive, access, store, or transmit confidential information
in the course of providing services on behalf of covered entities comply with certain obligations regarding
the confidentiality, integrity, and availability of health information as defined in the aforementioned
regulations. Accordingly, the parties agree to comply with those regulations as they may apply in the
course of providing services hereunder. The parties agree to (1) comply with all Privacy Laws and the
HITECH Act, as applicable to this Agreement, and (2) to negotiate in good faith and to execute any
amendment to this Agreement that is required for the terms of this Agreement to comply with applicable
Privacy Laws and/or the HITECH Act. In the event the parties are unable to agree on the terms of an
amendment to this Agreement pursuant to this paragraph within thirty (30) days of the date the amendment
request is delivered by one party to the other party (the Renegotiation Period ), this Agreement may be
terminated by either party upon written notice to the other party.
C.Discrimination. The Program and all related activities shall be conducted in a manner that does not
discriminate against any person on a basis prohibited by applicable law, including but not limited to: race,
color, national origin, religion, sex, sexual orientation, age, veteran status, or disability.
D.Assignment. Neither party hereto may assign this Agreement or a Program Agreement without the prior
written approval of the non-assigning party.
E.Entire Agreement; Amendment. This Agreement and any attached Exhibit(s) hereto supersede all prior
agreements, written or oral, between Sponsoring Institution and Facility, including the MedStar
Agreement as identified above, and will constitute the entire understanding between the parties with
respect to the subject matter hereof. This Agreement and each of its provisions will be binding upon the
parties and may not be waived, modified, nor amended unless reduced to a writing signed by an authorized
representative of each party.
F.Captions. The caption of sections and subsections in this Agreement are for convenience only and will
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
not be considered or referred to in resolving questions of interpretation or construction.
G.Notices. Except as otherwise provided by this Section, all notices, consents, approvals, demands, requests
or other communications provided or permitted under this Agreement will be in writing and sent via
certified mail, hand delivery, overnight courier, facsimile transmission (to the extent a facsimile number
is set forth below), or email (to the extent an email address is set forth below) as provided below, and
notice will be deemed given (i) if delivered by certified mailed, when deposited, postage prepaid, in the
United States mail, or (ii) if delivered by hand, overnight courier, facsimile (to the extent a facsimile
number is set forth below) or email (to the extent an email address is set forth below), when received:
If to Sponsoring Institution: The University of Texas Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, TX 75390-9013
Attention: Executive VP for Business Affairs
with copy to: The University of Texas Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, TX 75390-9056
Attention: Legal Contract Services
Email: contracts@utsouthwestern.edu
If to Facility: City of Fort Worth
2900 Alta Mere Drive
Fort Worth, TX 76116
Attention: Jeffrey Jarvis, M.D.
Email: Jeffrey.Jarvis@fortworthtexas.gov
100 Fort Worth Trail
Fort Worth, Texas 76102
or other person or address as may be given in writing by either party to the other in accordance with this
Section.
H.Governing Law. This Agreement and any attached Exhibit(s) hereto will be construed, interpreted, and
applied in accordance with, governed by, and enforced under the laws of the State of Texas.
I.Breach of Contract Claims. To the extent that Chapter 2260, Texas Government Code, is applicable to the
Agreement and is not preempted by other applicable law, the dispute resolution process provided for in
Chapter 2260 and the related rules adopted by the Texas Attorney General pursuant to Chapter 2260, will
be used by Sponsoring Institution and Facility to attempt to resolve any claim for breach of contract made
by Facility that cannot be resolved in the ordinary course of business. The chief business officer of
an effort to resolve such claims. The parties specifically agree that (i) neither the execution of the
Agreement by Sponsoring Institution nor any other conduct, action or inaction of any representative of
Sponsoring Institution relating to the Agreement constitutes or is intended to constitute a waiver of
Institution has not
waived its right to seek redress in the courts.
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
J.Public Information. Sponsoring Institution strictly adheres to all statutes, court decisions and the opinions
of the Texas Attorney General with respect to disclosure of public information under the Texas Public
Information Act (TPIA ), Chapter 552, Texas Government Code. In accordance with Section 552.002
of TPIA and Section 2252.907, Texas Government Code, and at no additional charge to Sponsoring
Institution, Facility will make any information created or exchanged with Sponsoring Institution pursuant
to the Agreement (and not otherwise exempt from disclosure under TPIA) available in a format reasonably
requested by Sponsoring Institution that is accessible by the public.
K.Press Releases. Facility will not make any press releases, public statements, advertisement, or other
promotional materials using the name or logo of Sponsoring Institution or the name of any Sponsoring
Institution employee, or referring to the Agreement, without the prior written approval of Sponsoring
Institution. Requests for prior written approval of any such releases, public statements, advertisements, or
t
Institutional Advancement.
L.Severability. In case any provision of this Agreement will, for any reason, be held invalid or unenforceable
in any respect, the invalidity or unenforceability will not affect any other provision of this Agreement, and
this Agreement will be construed as if the invalid or unenforceable provision had not been included.
M.Waiver. The failure of any party to exercise any of its rights under this Agreement for a breach thereof
shall not be deemed to be a waiver of such rights, and no waiver by any party, whether written or oral,
expressed or implied, of any rights under or arisingfrom the Agreement shall be binding on any subsequent
occasion; and no concession by any party shall be treated as an implied modification of the Agreement
unless specifically agreed in a writing signed by authorized representatives of both parties.
N.Force Majeure. Neither party shall be liable or deemed to be in default for any delay or failure in
performance under this Agreement or interruption of service resulting, directly or indirectly, due to causes
beyond its reasonable control, including but not limited to: acts of God, strikes, epidemics, war, riots,
flood, fire, sabotage, or any other circumstance of like character.
O.Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed
an original for all purposes and all of which shall constitute one and the same instrument for all purposes.
P.Limitations. THE PARTIES ARE AWARE THAT THERE ARE CONSTITUTIONAL AND STATUTORY LIMITATIONS
ON THE AUTHORITY OF SPONSORING INSTITUTION (A STATE AGENCY) TO ENTER INTO CERTAIN TERMS AND
CONDITIONS THAT MAY BE PART OF THE AGREEMENT,INCLUDING, BUT NOT LIMITED TO, THOSE TERMS
AND CONDITIONS RELATING TO LIENS ON SPONSORING INSTITUTION S PROPERTY; DISCLAIMERS AND
LIMITATIONS OF WARRANTIES; DISCLAIMERS AND LIMITATIONS OF LIABILITY FOR DAMAGES ; WAIVERS,
DISCLAIMERS AND LIMITATIONS OF LEGAL RIGHTS , REMEDIES, REQUIREMENTS AND PROCESSES ;
LIMITATIONS OF PERIODS TO BRING LEGAL ACTION;GRANTING CONTROL OF LITIGATION OR SETTLEMENT
TO ANOTHER PARTY; LIABILITY FOR ACTS OR OMISSIONS OF THIRD PARTIES; PAYMENT OF ATTORNEYS
FEES; DISPUTE RESOLUTION; INDEMNITIES;AND CONFIDENTIALITY (COLLECTIVELY, THE
LIMITATIONS AND TERMS AND CONDITIONS RELATED TO THE LIMITATIONS WILL NOT BE BINDING ON
SPONSORING INSTITUTION EXCEPT TO THE EXTENT AUTHORIZED BY THE LAWS AND CONSTITUTION OF
THE STATE OF TEXAS.
IN WITNESS WHEREOF, authorized representatives of Sponsoring Institution and Facility have executed this
Agreement as of the Effective Date.
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
Signature page as follows:
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
Sponsoring Institution:
THE UNIVERSITY OF TEXAS
SOUTHWESTERN MEDICAL CENTER
By: Sherry C. Huang, M.D.
Title: Vice Provost and Senior Associate Dean
For Education
UT Southwestern Medical School
Date: _________________________
By: Michael Green, M.D.
Designated Institutional Official
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
[Executed effective as of the date signed by the Assistant City Manager below.] / [ACCEPTED AND
AGREED:]
Facility:
By: ___________________________
Name: Valerie Washington
Title: Assistant City Manager
Date: ___________________
CITY OF FORT WORTH INTERNAL ROUTING PROCESS:
Approval Recommended:
By: ______________________________
Name: Jeffrey Jarvis, M.D.
Title: Director, Office of Medical Director
Approved as to Form and Legality:
By: ______________________________
Name: Taylor C. Paris
Title: Assistant City Attorney
Contract Authorization:
M&C: N/A
Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
By: ______________________________
Name: Dwayne Howerton
Title: D.D., Office of Medical Director
City Secretary:
By: ______________________________
Name: Jannette S. Goodall
Title: City Secretary
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
EXHIBIT A
Emergency Medical Services Fellowship Program Agreement
1. Persons Responsible for Education and Supervision.
Sponsoring Institution: Gilberto A. Salazar, M.D.
Facility: Brian Miller, M.D.
The above-mentioned people are responsible for the education and supervision of the Trainees while
rotating at Facility.
2. Responsibilities.
The Supervising Faculty Member at Facility must provide appropriate supervision of Trainees in patient
care activities and maintain a learning environment conducive to educating the Trainees in the ACGME
competency areas. The Supervising Faculty Member must evaluate Trainee performance in a timely
manner during each rotation or similar educational assignment and document this evaluation at completion
of the assignment.
The Supervising Faculty Member responsible for supervising the Trainees will:
1. Supervise Trainees doing clinical rotations at the Facility.
2. Provide educational objectives and goals for the rotations.
3. Evaluate Trainee performance at mid-rotation as well as end of rotation.
3. Content and Duration of the Educational Experiences.
Identifier PY Level Duration
Fellow PY1 Seven 4-week blocks throughout the year
The content of the educational experiences has been developed according to ACGME
Residency/Fellowship Program Requirements, and include the following goals and objectives as presented
in Attachment 1.
Sponsoring Institution: Facility:
By: _______________________________________ By:
Name: Gilberto A. Salazar, M.D. Name: Brian Miller, M.D.
Program Director Supervising Faculty Member
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
ATTACHMENT 1
Goals and Objectives
PY1
Emergency Medical Services Fellowship Program
City of Fort Worth
OVERALL EDUCATIONAL OBJECTIVES
Emergency Medicine Services is a one-year fellowship where fellows are PY- 1s.
They will plan to spend 7 4-week blocks months out of their fellowship year rotating at the City of Fort Worth.
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health.
Fellows must demonstrate competence in the practice of patient evaluation and treatment of patients of all
ages and genders requiring emergency medical services by:
1) Gathering accurate, essential information in a timely manner.
2) Evaluating and comprehensively treating acutely ill and injured patients in the pre-hospital setting.
3) Prioritizing and stabilizing multiple patients in the pre-hospital setting while performing other
responsibilities simultaneously.
4) Properly sequencing critical actions for patient care.
5) Integrating information obtained from patient history, physical examination, physiologic recordings, and
test results to arrive at an accurate assessment and treatment plan.
6) Integrating relevant biological, psychosocial, social, economic, ethnic, and familial factors into the
evaluation and treatment of their patients; and,
7) Planning and implementing therapeutic treatment, including pharmaceutical, medical device, behavioral,
and surgical therapies.
Fellows must be able to perform all medical, diagnostic, and surgical procedures considered essential for
the area of practice.
Fellows must demonstrate competence in the practice of technical skills for patients of all ages and
genders requiring emergency medical services by performing physical examinations relevant to the
practice of emergency medical services and performing the following KEY INDEX PROCEDURES:
(minimum requirements are in parenthesis)
1) Participate in a mass casualty/disaster triage at an actual event or drill (1).
2) Participate in a sentinel event investigation (1).
3) Conduct a quality management audit (1).
4) Participate in a mass gathering medical plan and its implementation (1).
5) Participate in the revision or development of an emergency medical services protocol (1).
6) Obtain vascular access in the prehospital setting (5).
7) Manage cardiac arrest in the pre-hospital setting (5).
8) Mange a compromised airway in the pre-hospital setting (5).
9) Provide direct medical oversight on-scene, or by radio or phone (100).
10) Participate in hazardous materials response training (1).
11) Participate in tactical EMS training (1).
12) Participate in confined space, technical rescue, or collapse/trench training (1); and,
13) Participate in vehicle rescue/extrication training (1).
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
MEDICAL KNOWLEDGE
Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological,
and social-behavioral sciences, as well as the application of this knowledge to patient care.
Fellows must demonstrate competence in their knowledge of the following:
1) Clinical manifestations and management of acutely ill and injured patients in the pre-hospital setting.
2) Disaster planning and response.
3) Evidence-based decision making.
4) Procedures and techniques necessary for the stabilization and treatment of patients in the pre-hospital
setting.
5) Provision of medical care in mass gatherings.
6)
medical oversight.
7) Experimental design and statistical analysis of data related to emergency medical services clinical
outcomes and epidemiologic research.
8) Models, function, management, and financing of emergency medical services systems.
9) Principles of quality improvement and patient safety; and,
10) Principles of epidemiology and research methodologies in emergency medical services.
PRACTICE-BASED LEARNING AND IMPROVEMENT
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and
assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation
and lifelong learning.
Fellows must demonstrate competence in the following:
1) Systematic analysis of practice using quality improvement methods and implement changes with the
goal of practice improvement.
2)
problems; and,
3) Demonstrate proficiency in the critical assessment of medical literature, medical informatics, clinical
epidemiology, and biostatistics.
INTERPERSONAL AND COMMUNICATION SKILLS
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of
information and collaboration with patients, their families, and health professionals.
Fellows must demonstrate competence in the following:
1) Ability to relate, with compassion, respect, and professional integrity, to patients and their families, as
well as other members of the health care team, sensitive issues, or unexpected outcomes, including
diagnostic findings, end of life issues and death, and medical errors;
2) Ability to work effectively as a member or leader of a health care team or other professional group.
3) Effective teaching techniques include teaching peers, emergency medical services personnel, other
health professionals, and patients.
4) Maintaining comprehensive, timely, and legible medical records; and,
5) Oral and written communication skills.
UT Southwestern Contract ID# FY2026-GME2-10132-NP
City of Fort Worth
PROFESSIONALISM
Fellows must demonstrate a commitment to professionalism and an adherence to ethical principles.
Fellows must demonstrate:
1) A commitment to ethical principles pertaining to the provision or withholding of clinical care,
confidentiality of patient information, informed consent, and business practice.
2) A commitment to lifelong learning and an attitude of caring derived from humanistic and professional
values.
3) High standards of ethical behavior, including maintaining appropriate professional boundaries and
relationships with other physicians, and avoiding conflicts of interest.
4) Respect, compassion, and integrity towards patients and other members of the health care team; and,
5)
SYSTEM-BASED PRACTICE
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health
care, including the social determinants of health, as well as the ability to call effectively on other resources
to provide optimal health care.
Fellows must demonstrate competence in:
1) Advocating for quality patient care and optimal patient care systems.
2) Appropriate resource allocation and utilization.
3) Cooperative interactions with other care providers
4) Interprofessional team participation for the enhancement of patient safety and the improvement of
patient care quality; and,
5) Leadership skills in the coordination and integration of care across a variety of disciplines and provider
types.
City Secretary’s Office
Contract Routing & Transmittal Slip
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.
Contractor’s Name:
Subject of the Agreement:
M&C Approved by the Council? *Yes No
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes No
If so, provide the original contract number and the amendment number.
Is the Contract “Permanent”? *Yes No
If unsure, see back page for permanent contract listing.
Is this entire contract Confidential?*Yes No If only specific information is
Confidential, please list what information is Confidential and the page it is located.
Effective Date: Expiration Date:
If different from the approval date. If applicable.
Is a 1295 Form required?* Yes No
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number:If applicable.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes No
Contracts need to be routed for CSO processing in the following order:
(Approver)
Jannette S. Goodall (Signer)
Allison Tidwell (Form Filler)