HomeMy WebLinkAboutScott Ulrich FY 214
{ Idaho Falls
School District 91
A [Yor•ld Class Educalion
690 John Adams Parkway
Idaho Falls, Idaho 83401
Phone: (208) 525-7500 FAX: (208) 525-7596
Web Address: www•d91.k12.id,us
Agreement for Medical Consultation Services and Signing
Uf
Physician Referrals for Purposes of School 13ased Medicaid Billing
This Agreement is made between the Idaho Palls School District 91, 690 John Adams Parkvvay,
Idaho balls, Idaho 8.3 401, hereafter referred to as School District and
Scott Ulrich, 390 Itockingham, Idaho Palls, ID 83404
208-681-5105, wsulrich(i)gmail.coin
Whereas, the School District wishes to obtain Medical Consultation services and Physician
Referral services for School Based Medicaid Billing and Scott Ulrich wishes to furnish these
services to the Schooi District,
Now Therefore, in consideration of the premises and the mutual promises and undertakings of
the parties hereafter set forth, the parties hereby agree as follows:
1. The teen of the Agreement shall be from June 1, 2020 forward.
2. Scott Ulrich will be available to provide medical consultation services (which means
briefconsultation regarding 4videspread outbreak of illnesses in the schools and 110".
best to treat or mitigate these circumstances), signul�cy of annual standing orders, and
the signing of'physlcian referrals for pUrposes of school based Medicaid blllin;-.
;. In consideration of these services School District 91 agrees to pay Scott Ulrich S5.00
per signature for these services. Payment will be made upon receipt of bill for
services rendered.
4. Both parties agree that services that may be needed beyond the scope of this
Agreement and such services 4vill be negotiated separately by the parties.
5. This agreement may be terminated by either party upon a 60 day written notice. An%
lees for services rendered will be paid based on a pro rate basis of the calendar year.
In Witness Therefore, the parties have set forth their signatures below:
/-, ld D C�
Date
Date
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