Influenza immunisation service Service agreement 2013 MARCH PSA Your voice.
Pharmaceutical Society of Australia Ltd., 2013 This handbook contains material that has been provided by the Pharmaceutical Society of Australia (PSA), and may contain material provided by the Commonwealth and third parties. Copyright in material provided by the Commonwealth or third parties belong to them. PSA owns the copyright in the handbook as a whole and all material in the handbook that has been developed by PSA. In relation to PSA owned material, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968 (Cth), or the written permission of PSA. Requests and inquiries regarding permission to use PSA material should be addressed to: Pharmaceutical Society of Australia, PO Box 42, Deakin West ACT 2600. Where you would like to use material that has been provided by the Commonwealth or third parties, contact them directly. Disclaimer Neither the PSA, nor any person associated with the preparation of this document, accepts liability for any loss which a user of this document may suffer as a result of reliance on the document and, in particular, for: use of the document for a purpose for which they were not intended any errors or omissions in the document any inaccuracy in the information or data on which the document are based or which is contained in them any interpretations or opinions stated in, or which may be inferred from, the document. 2 Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd.
Contents Parties 4 Definitions 4 Service 5 Location 5 Confirmation 5 Cancellations 5 Vaccines 5 Approvals, licences and permits 5 Standard of performance 5 Consent 5 Eligibility and screening 6 Observation 6 Privacy and confidentiality 6 Indemnity insurance 6 Payment 6 Price 6 Terms of payment 6 Dispute resolution 6 Agreement period 7 Authority to sign 7 Declaration 7 Client 7 Service provider 7 Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd. 3
Parties Agreement for the provision of influenza vaccination services between: and Address: Representative: Contact number: ACN: ABN: Address: Representative: Contact number: ACN: ABN: Definitions Client - the pharmacy contracting influenza immunisation services Consumer/s - includes all customers of the client participating in the service Premises - the address of the client Services - the provision of the influenza vaccination clinic Service provider - the company or individual providing influenza immunisation services 4 Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd.
Service The Service provider will provide the Client with influenza vaccination services in accordance with this Agreement. Location The Service provider agrees to provide Services at the premises on the agreed dates/s and time/s. Confirmation The date/s and time/s of Services must be agreed and confirmed by both Parties in writing. The Client will confirm the exact number of consumers with the Service provider days prior to Services. The minimum number of consumers required is. If the minimum number of consumers is not met, the Service provider may cancel or reschedule Services at their discretion and the Client will need to notify any booked consumers of the cancellation or change. Cancellations The Client must give days notice for the cancellation of Services without penalty. Cancellations made within this time of the scheduled booking will attract a cancellation fee of $ plus GST. Once the date and time for Services has been agreed, changes to the booking may attract a fee of $ plus GST at the discretion of the Service provider. Vaccines The service provider will provide one vaccine for each confirmed consumer. Extra vaccines may be available on the day however the Service provider cannot guarantee that a vaccine will be available for any consumer that was not confirmed by the agreed date. The Service provider is responsible for maintaining the viability of all vaccines through appropriate cold chain procedures. Approvals, licences and permits The Client is responsible for obtaining any approvals, licences or permits necessary for the performance of Services in accordance with this Agreement. By signing this Agreement the Client warrants that it holds or has obtained the necessary approvals, licences or permits to allow the Service provider to consult with consumers on the premises. Standard of performance The Service provider will perform Services in accordance with the highest degree of care, diligence, foresight, prudence and skill exercised by skilled and experienced professionals providing similar services, including complying with all jurisdictional legislation and industry standards. The Service provider warrants that it possesses and will deploy the specific skills and experience relevant to deliver Services according to this Agreement. Consent The Service provider requires documented consent to receive the influenza vaccine from each consumer prior to vaccination. Consent must include agreement from the consumer to meet the cost of any medical treatment required in connection with vaccination. Consent forms will be provided by Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd. 5
Eligibility and screening The Service provider is responsible for conducting pre-vaccination screening to determine the eligibility of each consumer to receive the influenza vaccine. Pre-vaccination screening forms will be provided by The Service provider reserves the right to refuse vaccination to any consumer at their discretion. Observation The Service provider or representative administering the vaccine will remain on site for 15 minutes post vaccination. In the unlikely event of a medical emergency, the Service provider will not be liable for the costs of any required medical treatment. Privacy and confidentiality All information contained within the consumer records is classified as sensitive information under the Privacy Act 1988 and as such cannot be disclosed to a third party without the consumer s consent. Indemnity insurance The Service provider holds indemnity insurance appropriate for delivery of Services in accordance with this agreement. The Service provider indemnifies the Client from and against all actins, claims, demands, costs and expenses made, sustained, brought or prosecuted against the Client by consumers based on any loss or damage to themselves which may arise in connection with any act or omission of the Service provider or representative in the delivery Services. The Client holds indemnity insurance appropriate for hosting of the Service provider on the premises and indemnifies the Service provider against all liability, claims and damages associated with the use of the premises. Payment Price The Client will collect payment of $ from each consumer on or before the day of vaccination. The Service provider will invoice the Client $ plus GST per consumer vaccinated. Terms of payment The invoice for Services provided is payable within days. At the discretion of the Service provider, failure to make payments in accordance with this Agreement may be treated as a repudiation of this Agreement. At the discretion of the Service provider, interest shall be paid by the Client on overdue accounts calculated on the daily balances from the day after payment was due, at the rate of % per annum and without any demand being necessary. Payment made by the Client shall be allocated first to the interest then to the unpaid invoices in the order of issue. Dispute resolution Parties to this Agreement must attempt to settle any dispute in relation to this Agreement by negotiation before resorting to external dispute resolution mechanisms. It the dispute is not settled by Parties within days of one party providing written notice of the dispute to the other party, the dispute must be submitted to an alternative dispute resolution mechanism. If Parties cannot agree on the alternative dispute resolution mechanism within days the mechanism will be chosen by the President of the relevant State Law Society. Each party will pay its own costs associated with the dispute resolution process. Costs incurred for mediation /arbitration will be shared equally. Parties agree that the decision of the mediator /arbitrator will be final. This clause survives the expiration or termination of this Agreement. 6 Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd.
Agreement period This Agreement is effective up to and including the date of Services. Authority to sign The person/s signing this Agreement warrants that they are duly authorised to enter into the Agreement. Declaration Executed as an Agreement. Client Signed for on behalf of: Service provider Signed for on behalf of: Full name:... Full name:... Position:... Position:... Signed:... Signed:... Date:... In the presence of Full name of witness:... Date:... In the presence of Full name of witness:... Signed:... Signed:... Date:... Date:... Influenza immunisation service agreement I Pharmaceutical Society of Australia Ltd. 7
PHARMACEUTICAL SOCIETY OF AUSTRALIA LTD. ABN 49 008 532 072 NATIONAL OFFICE Pharmacy House 44 Thesiger Court Deakin ACT 2600 PO Box 42 Deakin West ACT 2600 P: 02 6283 4777 F: 02 6285 2869 E: psa.nat@psa.org.au www.psa.org.au BRANCH CONTACT DETAILS P: 1300 369 772 F: 1300 369 771 AUSTRALIAN CAPITAL TERRITORY 44 Thesiger Court Deakin ACT 2600 PO Box 42 Deakin West ACT 2600 E: act.branch@psa.org.au NEW SOUTH WALES 82 Christie Street St Leonards NSW 2065 PO Box 162 St Leonards NSW 1590 E: nsw.branch@psa.org.au QUEENSLAND PACE Level 3, West Wing 20 Cornwall Street Dutton Park QLD 4102 PO Box 6120 Buranda QLD 4102 E: qld.branch@psa.org.au SOUTH AUSTRALIA Suite 7/102 Greenhill Road Unley SA 5061 E: sa.branch@psa.org.au TASMANIA 161 Campbell Street Hobart TAS 7000 E: tas.branch@psa.org.au VICTORIA Level 1, 381 Royal Parade Parkville VIC 3052 E: vic.branch@psa.org.au PSA3925