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DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 <br /> 2. Relationship with Provider. MDP understands that once Freedom House accepts an <br /> individual referred by MDP, that individual becomes a Freedom House client. Except as <br /> specifically set forth herein, Freedom House will follow its standard policies and procedures <br /> while providing services under this Agreement. All individuals accepted into Freedom <br /> House's program under this Agreement will have the same privacy rights as all other <br /> Freedom House patients. MDP will obtain the written permission of all individuals accepted <br /> into Freedom House's program to allow Freedom House to disclose the individual's <br /> attendance at Freedom House sessions for invoice purposes. In the event the MDP <br /> terminates an individual's participation in the MDP, MDP will immediately notify Freedom <br /> House, and Freedom House will no longer provide services to that individual under this <br /> Agreement. <br /> 3. MDP Responsibilities. MDP will provide Freedom House with a referral form that includes <br /> relevant client information, including medical and payment information when available. In <br /> addition, MDP will pay Freedom House the fee of $120 per referral accepted by Freedom <br /> House. The amount of the fee will not vary based upon the amount of services provided by <br /> Freedom House to MDP as long as Freedom House provided at least one session to the <br /> individual. The MDP understands that Freedom House will pay all third party payors, <br /> including private insurance payors and governmental payors such as Medicaid. Freedom <br /> House will not consider the existence of a third party payor when deciding whether to accept <br /> a referral of a MDP client and will base such decisions on clinical information only. Due to <br /> the nature and purpose of MDP, Freedom House agrees that it will waive all amounts that <br /> would otherwise be the responsibility of the patient or the patient's family, including without <br /> limitation copays. The total amount of this Agreement shall not exceed $5,000 without <br /> written amendment, <br /> 4. Confidentiality. Except as otherwise subject to the North Carolina Public Records Law, no <br /> person will publish or disclose, use, or permit to be published, disclosed, or used, any <br /> confidential information pertaining to referrals or participants. Any information deemed <br /> confidential under state or federal law provided to or developed by any of the Parties in the <br /> performance of the duties described in this MOU shall be kept confidential and shall not be <br /> made available to any individual or organization without the approval of all Parties; however, <br /> the Parties shall make administrative, fiscal, program and participant records available as <br /> required by law for audit purposes to assist in the performance of state/federal <br /> responsibilities or grant requirements. Parties shall notify remaining Parties promptly of any <br /> unauthorized possession, use, knowledge or attempt thereof, of any other Parties data files or <br /> other confidential information and shall promptly furnish to that party full details of the <br /> unauthorized release of such confidential information and shall assist with the investigation <br /> or prevention of the further release of such information. <br /> 5. Duration of Services. This Agreement will continue until terminated by either party. Either <br /> party may terminate this Agreement at any time upon written notice to the other party. In the <br /> event of a termination, all individuals already accepted by Freedom House under referral by <br /> MDP will continue to be subject to this Agreement. <br /> 6. Amendments. Any amendment to this Agreement shall not be valid unless made in a writing <br /> signed by both parties. <br /> 2 <br />