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Clinic Policy Manual

Affiliation Agreement Policy

Subject: Affiliation Agreements
Policy Number:
Effective Date: October 2004
Revision Dates: August 2004, August 2016

Purpose

To provide a systematic process for establishing and maintaining affiliation agreements with participating institutions or organizational units. All Affiliation agreements should ensure that the same standards are in place at the extramural sites as at the main teaching site.

General Policy

Affiliation agreements represent a binding, legal agreement for providing clinical instruction at locations outside the University of Washington’s School of Dentistry clinics.  These legal documents are required by the University of Washington Health Sciences and the School of Dentistry to indemnify its students and faculty.  It is necessary for the agreement to be fully executed with original signatures and dated by both the University of Washington and the affiliating site to be considered complete.

Standard 1-6 of the ADA accreditation standards for dental education programs require dental schools to develop formal agreements with participating institutions which define the responsibilities of each institution with respect to objectives of the training experience, facilities, faculty supervision, and evaluation of students and support staff.

Implementation

A. PROGRAMS REQUIRING AN AFFILIATION AGREEMENT

An affiliation agreement is required when a student or faculty member from the School of Dentistry participates in the following types of programs:

  1. Continuous regular instructional programs at non-University of Washington (UW) institutions, except Harborview Medical Center and other institutions which have inter-institutional affiliations with the UW Health Sciences Center.
  2. Continuous residency programs at non-UW institutions.
  3. Programs with students from other universities spending time at the University of Washington School of Dentistry on an elective rotation.
  4. Programs/activities that are funded all, or in part, by grants and contracts to perform collaborative research/instructional training that takes place at non-UW institutions and where the affiliation terms are not otherwise incorporated within the grant, contract, consortium, or other related agreements or other documents.
  5. The UW student-run Husky Smiles volunteer program.
  6. Agreement on Academic Exchange used by visiting exchange faculty or students.
  7. Proposed sites with the RIDE, Robert Wood Johnson, (RWJ) or other outreach programs to expand to states beyond Washington and perhaps to include private practice clinics.

B. FORMAL DOCUMENTATION

  1. A proposal for a new affiliation agreement must be submitted by a Department Chair to the Office of the Dean prior to the initiation of an affiliation arrangement.
  2. The draft affiliation agreement must be prepared using the University of Washington School of Dentistry Affiliation Agreement template (see Appendix A).
  3. This template utilizes formatting and clauses specified by the UW Attorney General’s Office (AGO) and/or the School of Dentistry and includes:
    1. A statement of the purpose of the affiliation;
    2. Objectives of the affiliation;
    3. Names of the liaisons at the School of Dentistry and affiliating site(s) (including titles, addresses, telephone numbers, and email);Note: For affiliations involving clinical work without Department Faculty supervision, a site visit by the Department Faculty is required.
  1. The draft affiliation agreement must be prepared using the University of Washington School of Dentistry Affiliation Agreement template (see Appendix A).
  2. For international faculty exchanges that do not involve clinical work, an International Agreement Proposal Form (See Appendix B) will be sent to the Department Chair(s) to provide basic information to the Office of Global Affairs (OGA) regarding the specifics of the site collaboration and contact information needed for the draft Affiliation Agreement preparation.

C. APPROVAL PROCESS

Affiliation agreements are processed by the Office of the Dean:

  1. Copies of the draft document are sent to the Department Chair and the affiliating site to request any changes to the initial draft.
  2. If necessary changes are requested to the basic template, those changes are sent to the AGO for review.
  3. Upon approval by the AGO, the document is sent to the signing parties at the affiliation site for final approval and signature.
  4. Once the signed agreement is returned, the agreement will be routed in the following sequence for signature: AGO (if changes were made to the basic template), Department Chair(s), Dean of the School of Dentistry, and Executive Director of Health Sciences Administration.
  5. Once the agreement is fully executed, the Authorized Records Monitor, School of Dentistry will scan the agreement into the Salesforce database as outlined in the Salesforce.com Records Scanning Policy (see appendix C).
  6. Depending on the site’s preference, either a scanned copy will be sent electronically or a hard copy will be sent through the mail to the affiliated site. An electronic copy of the fully executed agreement will be forwarded to the originating department(s).

Affiliation Agreements which go beyond individual schools and colleges and have broader University implications will be forwarded by the Authorized Records Monitor, School of Dentistry, to the Administrator, OGA.

In addition, a copy of affiliation agreements with colleges and universities outside the United States for exchanges of faculty or students will be forwarded by the Authorized Records Monitor, School of Dentistry to the Administrator, OGA.

D. PERIODIC REVIEW

The agreements shall be reviewed every five years or earlier at the request of either party.  At the end of the five-year period, the Authorized Records Monitor, School of Dentistry will review the agreement with the designated Department Chair(s). Upon review, if the affiliation is active and the terms of the agreement are still acceptable to all parties, the agreement will remain unchanged and will be designated for review in five years.

E. AMMENDMENTS

If there are any substantial changes to the terms that require revisions, the proposed changes will be drafted in an Amendment to Affiliation Agreement (See Appendix D) and sent to the AGO for approval. Depending on the scope of the changes, a new, updated affiliation agreement will be prepared and submitted for signature as provided in Section II above. If the Department Chair(s) indicate that the affiliation is no longer active, the Authorized Records Monitor will mark the agreement as inactive in the Salesforce Database.

Appendices:

Appendix A, University of Washington School of Dentistry Affiliation Agreement template
Appendix B, International Agreement Proposal Form
Appendix C, Salesforce.com Records Scanning Policy
Appendix D, Amendment to Affiliation Agreement

Dean of UW SOD

Joel Berg, Dean of the UW School of Dentistry

Appendix A, University of Washington School of Dentistry Affiliation Agreement template (PDF)

Appendix B, International Agreement Proposal Form (PDF)

Appendix C, Salesforce.com Records Scanning Policy (PDF)

Appendix D, Amendment to Affiliation Agreement (PDF)