HomeMy WebLinkAboutScott Ulrich'ri. .
'Idaho Falls
School District 91
A World Class Education
690 f ohn Adams Parlrway
Idaho Falls, Idaho 83401
Phone: (208J525-7500 FAX: (20S) 525-7596
Web Address: www.d9 1.k1 Zid.us
Agreement for Medical Consultation Services and Signing
or
Physician Referrals for Purposes of School Based Medhail Billing
This Agreement is made betu,een the Idaho Falls School District 91, 690 John Adams Parkway,
Idaho Falls, Idaho 83401, hereafler referred to as School District and
Scott Ulrich, 390 Rockingham, Idaho Falh, ID 83404
208-681-5 105, wsulrich@gmailcom
Whereas, the School District wishes to obtain Medical Consuhation services and Physician
Referral services for School BasedMedicaid Billing and Scott Ulrich wishes to furnish these
services to the School Distict;
Now Therefore, in consideration oflhe premises and the mutual prombes and undertakings of
the parties hereafter set fortb the parties hereby agree as follows:
i .;
l. The termof the Agreement shall be from August 1,2022 to July 31,2073.
2. Scott Ulrich will be avaihble to provide medbal corsultation services (which means
brief consultation regarding widespread outbreak of ilhesses in the schools and how
best to treat or mitigate these circumstances), signing of annual standing orders, and
the signing ofphysician referrals for purposes of school-based Medicaid billing.
3. In consideration ofthese services School District 9l agrees to pay Scott Ulrich $5.00
per signah:re for these services. Payment will be made upon receiplof bill for
services rendered. :
4. Both parties agree that services that may be needed beyond lhe scope of this
Agreement and such services will be negotiated separately by the parties.
5. This agreement may be terminated by either party upon a 6&day written notice. Any
fees for services rendered will be paid based on a pro rata basis ofthe calendar year.
fore, Lhe parties have set forth thet signatures below:In Witness Therc
71zaba*
Sc A.C
Andrea Williams, Director of S
Date
olrl aa
lrich,
tSe Date
EH cu.ns.u,',n".
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