SOUND OFF INC.
CLINICIAN SERVICES AGREEMENT
This Agreement (the “Agreement”) is made and entered into this _________ day of ____________________, 20___, (the “Effective Date”) by and between Sound Off, Inc., a Texas nonprofit corporation, (“Company”) and ________________________________, whose address is __________________ (“Clinician” or “you”). Company and Clinician may be referred to in this Agreement collectively as “the Parties” and singularly as a “Party.”
__Clinical Psychologist; __ Licensed Clinical Social Worker; __ Licensed Professional Counselor; __ Psychiatrist M.D. ; __ Psychoanalyst M.D.
NOW, THEREFORE, in consideration of the promises and mutual agreements contained in this Agreement, the Parties, intending to be legally bound, agree as follows:
1.1 Services; Crisis Counseling. Clinician shall provide Services to Users by means of the Application through the mobile application on an anonymous basis. Clinician agrees not to request or require the name, age, gender, address or any other identifying information from the User, except under the circumstances discussed below. Clinician shall provide Services to Users only through the Company Application unless the User specifically and voluntarily requests communication in another manner or asks to be seen in person by Clinician. Clinician shall arrange a schedule for the Services, including the frequency and duration of the communications between Clinician and User, directly with the User based on the Clinician’s judgment and clinical determination of the specific needs of the User. Should you as Clinician agree to provide services to a User in person or by means other than through the anonymous online Services arrangements offered by the Company’s Application, which you are entirely free to do in the exercise of your professional judgment and/or as an accommodation to the perceived needs of such User, then you must discontinue providing any Services thereafter through the Company’s Application to such User and advise such User that such User’s arrangement for services thereafter shall be only directly with you as Clinician and that User’s relationship with the Company shall be thereafter terminated; you agree that under no circumstance will you disclose to the Company any such personally identifying information obtained by you as Clinician concerning such a User. Furthermore, you will notate in the Application that your relationship with that User has been discontinued on the Application and will be continued by other means.
Should Clinician in the course of providing Services to any User encounter a crisis situation in which the Clinician determines that there is a probability of imminent physical injury by such User to himself or herself or others or there is a probability of immediate mental or emotional injury to such User, you as Clinician shall exercise your own professional judgment with respect to such crisis situation, including as to whether and when it becomes appropriate to attempt to elicit personally identifiable information concerning the User (“PII”), contact information of the User, or User’s location, and/or to report such elicited PII information to law enforcement authorities or medical personnel geographically nearer the User, and/or whether to particularly direct or recommend that such User directly access the Veterans’ Administration crisis line link contained within the Application where you as Clinician in the exercise of your judgment believe that any one or more of such measures are appropriate or mandated by your professional or other responsibilities.
1.2 Clinician Affiliated Entities and Agreements. In the event that Clinician is employed by or in any other way affiliated with and performing Services of the type contracted for hereunder on behalf of any entity (a “Clinician’s Affiliated Entity”) with which the Company has a direct organization-to-organization agreement (the “Clinician’s Affiliated Entity Agreement”) for the provision of counseling services of the type contemplated hereby, the terms of such Clinician’s Affiliated Entity Agreement shall control to the extent otherwise inconsistent herewith and each Party hereby in such case undertakes to strictly comply in all respects with such Clinician’s Affiliated Entity Agreement.
1.3 Quality. Clinician shall provide all Services to Users in compliance with professional standards and with all applicable state, federal and local laws and regulations. Clinician shall exercise independent professional judgment when providing Services.
1.4 Licensure and Staff Qualifications. You as Clinician shall hold and maintain all current licenses, certificates and permits as required by law for the provision of Services pursuant to this Agreement, and agree to provide Company with proof of same, upon request. Clinician shall provide Company with other pertinent documentation as reasonably requested by Company, including, but not limited to, the following: background checks, copies of professional licenses, proof of competency, and education and experience. Clinician shall immediately notify Company in the event of any limitation, suspension or termination of any license, certificate or permit required for Clinician to provide Services to Users pursuant to this Agreement.
1.5 Payment. All Services provided by Clinician to Users pursuant to this Agreement and the Application shall be free to the User. Neither Company nor User shall have any financial obligation to Clinician or to any Clinician’s Affiliated Entity for the performance of Services or for any other purpose.
1.6 Clinical Documentation; Surveys. Clinician shall maintain complete and accurate documentation of all Services provided to Users. Clinician shall prepare such clinical and other documentation in accordance with sound professional practice, state and federal laws and regulations, and Company policies and procedures. Clinician’s records of Services provided to Users shall remain the property of Clinician or, as applicable, any Clinician’s Affiliated Entity. Clinician shall also complete and provide to the Company such survey information (which will be designed not to elicit personal identifying information concerning Users) with respect to Clinician’s counseling of and interaction with Users as the Company may reasonably require from time to time.
1.7 Legal Compliance. Clinician shall provide Services to Users pursuant to this Agreement in compliance with all applicable laws, including the provisions of the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. §§ 1320d-1329d-8, as amended by the Health Information Technology for Economic and Clinical Health Act, enacted as Title XIII of the American Recovery and Reinvestment Act of 2009, Public Law 111-5 (collectively, “HIPAA”) to the extent applicable. A User’s Protected Health Information (“PHI”) is defined in HIPAA (and in Texas Law) as individually identifiable health information, including demographic information that (a) is created or received by a Covered Entity, and (b) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the health care if the information identifies or could be used to identify the individual. A Covered Entity is a health care provider, a health plan, a health care clearinghouse and, in certain limited circumstances, an employer. For purposes of the Sound Off Application and Services, the Clinician is a Covered Entity and subject to HIPAA if and to the extent that Clinician comes into possession of PHI concerning a User, although except when the User voluntarily discloses PHI and PII to the Clinician during the course of Services or when the Clinician under the crisis circumstances referenced in Section 1.1 hereof attempts to elicit such PHI and/or PII, the Application is designed to avoid the Clinician coming into possession of such PII or PHI. The Company would not be a Covered Entity under HIPAA but may meet the definition of Covered Entity under Texas law if the Company has access to or obtains PHI from the Clinician, although every effort has been made in the design of the Application to avoid the Company coming into possession of such PII or PHI, and the Clinician accordingly hereby agrees to avoid providing to the Company any such PHI or PII as may come into Clinician’s possession in the course of providing Services.
Furthermore, Clinician acknowledges that the Company has expended substantial time, effort and funds to create the Application and to provide the services that are available on or through the Application. Sound Off reserves all rights to the Application. Clinician understands and agrees that the Company owns or has been licensed by third parties to use all right, title, and interest in and to the Application and all information, text, data, software, and other materials contained therein, and the compilation, collection, design, selection, and arrangement thereof. Clinician acknowledges that the Application contains valuable proprietary information that is protected by applicable intellectual property and other proprietary rights and laws of the United States and that Clinician acquires no ownership interest or rights by accessing and using the Application.
2.1 Maintenance of Application. Company shall establish and maintain a mobile Application through which the User may obtain and the Clinician may provide Services.
2.3 Company Insurance Coverage. The Company will at all times maintain an E&O liability insurance policy with aggregate $5 million coverage, and the Company will provide coverage to Clinicians and Battle Buddy non-professional peer counselors as additional named insureds thereon (but subject to, and secondary to, the insurance coverage required to be maintained by Clinician pursuant to Section 4 hereof) and shall provide Clinician with proof of same upon execution of this Agreement and periodically as requested.
3.2 Injunctive Relief. If any action is brought by Company for Clinician’s violation of Section 3.1 of this Agreement, Clinician agrees that because of the immediate and irreparable injury that would be sustained by Company if such violation were to continue, an order may be entered enjoining Clinician from violating any such covenant, either temporarily, preliminarily or as part of a final judgment, all without a requirement that Company post bond. Company’s application for injunctive relief will not prejudice any other claim or cause of action that it or its assignees may pursue by reason of the violation of these covenants, nor will it prejudice Company’s right to maintain any other claim or cause of action under this Agreement.
3.3 Survival. The terms of this Section 3 shall survive termination of this Agreement.
6.1 Term. This Agreement shall commence on the Effective Date and shall continue until terminated as provided in Section 6.2.
6.2 Termination. This Agreement may be terminated by the Company at any time and for any reason upon written notice to the Clinician. This Agreement may be terminated at any time and for any reason by the Clinician but only upon written notice from the Clinician to the Company given at least thirty (30) days prior to the intended date of termination. In addition, this Agreement shall terminate immediately upon the revocation or suspension of Clinician’s license or certification to provide the Services, upon Clinician’s failure to maintain insurance as required in this Agreement, or upon the breach by Clinician of your obligation of confidentiality.
7.1 Independent Contractors. It is expressly agreed and understood by Company and Clinician that Clinician, by entering into and performing your obligations under this Agreement, is an independent contractor. Nothing in this Agreement or the actions of the Parties shall be construed to characterize the relationship between the Parties as that of employer/employee, partnership or co-venture, or agency. Company shall treat Clinician as an independent contractor for all purposes, including control over the Services delivered by Clinician, federal or state tax purposes, if any, and workers’ compensation laws. Clinician shall be solely responsible for all filings and reports required for Clinician to make relating the Services performed pursuant to this Agreement.
7.2 Entire Agreement. This Agreement shall constitute the entire agreement between the Parties and supersedes all prior oral or written agreements or understandings, subject if applicable to the provisions of any Clinician’s Affiliated Entity Agreement pursuant to Section 1.2 hereof. This Agreement may be modified or amended only in a writing signed by the Parties.
7.3 Assignment. This Agreement may not be assigned in whole or in part by either Party without prior written consent by the other Party.
7.4 Nondiscrimination. Clinician shall not discriminate in the provision of Services on the basis of race, religion, national origin, sex, age, color, disability or other basis prohibited by law. Further, Clinician shall respect Users’ rights, as set forth under applicable law and regulations, in providing Services.
7.5 Controlling Law. The rights and obligations of the Parties under this Agreement, and any claims or disputes relating to the Agreement, shall be governed by the laws of Texas.
7.6 Partial Invalidity. Each provision of this Agreement shall be deemed independent and terminable. The exclusion of any provision herein found to be invalid or illegal shall not affect enforcement of the remaining provisions of the Agreement.
7.7 Notices. Any notice required or permitted under this Agreement shall be in writing addressed to the Parties and sent to the addresses provided in this Agreement.
IN WITNESS WHEREOF, the Parties or their duly authorized representatives have executed this Agreement on the date first set forth above.
SOUND OFF, INC. CLINICIAN
By: _______________________________ By: ______________________________