Student Clinical Rotation Agreement

Student Clinical Rotation Agreement 

I, ______________, (referred to as ‘Student’), will be participating in a clinical rotation in the U.S. with Dr. Nilanjana Bose at Lonestar Rheumatology PLLC, during the period ***, under the following terms and conditions:

⦁    Student will NOT engage in the “Practice of Medicine” as Student is not licensed to do so. Student is solely responsible for maintaining compliance with all federal, state, and local rules, laws, and regulations regarding the clinical practice of medicine. 

⦁    Patient Confidentiality is legally binding. Students must not discuss patient information with their friends, colleagues, or anyone who is not authorized to be involved in that patient’s care. By participating in this program, you agree that you have familiarized yourself with HIPAA rules and regulations and will not transmit any protected information to unauthorized parties.

⦁    Patient Confidentiality is legally binding. Students must not discuss patient information with their friends, colleagues, or anyone who is not authorized to be involved in that patient’s care. By participating in this program, you agree that you have familiarized yourself with HIPAA rules and regulations and will not transmit any protected information to unauthorized parties.

By signing this contract, you agree you have reviewed a reliable source for HIPAA guidelines and agree to abide by the rule.

⦁    Student is responsible for all other fees and expenses connected to or in consequence of Student’s participation in the Clinical Experience, including but not limited to transportation to and from the United States, housing costs, meals, local transportation, medical care, and other incidentals. 

⦁    Student is solely responsible for maintaining strict compliance with any and all federal and state VISA terms and regulations during their stay in the United States. The student is fully responsible for applying for and getting the appropriate type of VISA for the clinical rotation. 

⦁    Student should purchase and maintain in full effect, during the duration of this Agreement, personal health insurance coverage. Student may elect to purchase and maintain in full effect during the term of this Agreement, professional and general liability insurances of no less than $1,000,000 per occurrence, and $3,000,000 aggregate, written to their respective standing as either a medical student or graduate, for injury and damage to persons or property resulting from the negligent acts or omissions, or willful misconduct that under this Agreement against claims, demands, losses, costs, expenses, and damage to persons or property arising out of or in connection with Student’s Clinical Experience. Student is responsible for obtaining the correct type of visiting medical liability insurance.

⦁    Lonestar Rheumatology PLLC shall not be liable for the consequences, whether bodily injury or property damage, occasioned by an act, omission, or neglect chargeable to the other party. 

⦁    INDEMNIFICATION: Student Shall hold Lonestar Rheumatology PLLC harmless from any liability, loss, or damage they may suffer as a result of claims, demands, costs, or judgments against them arising out of the activities to be carried out pursuant to the obligations of this agreement. 

⦁    Student holds full liability for any errors (medial or non-medical) committed by the student during the rotation period.

⦁    Student shall maintain strict compliance with all applicable physician directions, regulations and protocols for the Clinical Experience

⦁    Fees paid by the Student are non-refundable if the Student was not able to show up to the rotation or was not able to get a visa. If notice is given 30 days prior to the start date of the rotation, a 50% refund could be processed and is up to the discretion of Lonestar Rheumatology. If notice is given less than 30 days prior to the rotation start date, NO refunds will be considered. 

⦁    Student agrees to record videos to share the Student’s experience with the clinical rotation if they were satisfied! Student grants Lonestar Rheumatology the right, but not the obligation, to use and to license to others the right to use these videos, Student's name, voice, photograph, likeness and biographical information in connection with and related to the Clinical Rotation.

⦁    Student agrees to pay 50% of the total fees at least 2 days prior to start date and the remaining 50% by the end of the second week for a 4 week rotation, and so forth.

⦁    Student can expect a Letter of Recommendation if their performance is above satisfactory, at the discretion of the Lonestar Rheumatology

Student:

Physician:

Nilanjana Bose MD MBA
Lonestar Rheumatology pLLC

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