PROPERTY MANAGEMENT COMPANY INFORMATION
Property Manager Contact Name
Estimated Number of Individuals to Receive Immunizations
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IF PREFERRED, PRINT FORM AND FAX TO: 206-524-3534
This form constitutes a Service Agreement between the above named Property Management Company and the Seattle Visiting Nurse Association (SVNA) to sponsor a 2013, on-site, seasonal Flu Immunization Clinic for tenants and employees of the above named Building at a date, time, and location to be agreed upon by both the Property Management Company and the Seattle Visiting Nurse Association..
Property Management Company agrees to provide an appropriate space where immunizations will be given and to assist Seattle Visiting Nurse Association by promoting the Flu Immunization Program to building tenants and their respective employees.
SVNA is a non-profit, tax-exempt, 501(c)(3) community based, immunization and wellness services provider.
SVNA does not require Property Management Company, as a Flu Clinic sponsor, to guarantee, assure or otherwise commit to any minimum tenant Flu Clinic participation. However, we do ask, and appreciate building management efforts to promote and support the event to achieve at least 20 immunizations per clinic.
SVNA does not charge any travel or other clinic administration fees. SVNA does not assess clinic cancellation fees.
Provide qualified RN and support staff to cover all clinic administration requirements.
Ensure security and privacy of identifiable health information as required by law.
Provide vaccine and all immunization supplies.
Provide clinic management services to include removal of medical waste (needles,syringes, used supplies).
Upon request, invoice individual tenants or bill tenant health insurance plan for their employee immunizations.
Provide seasonal Flu Shot for building/tenant employees at a fee of $28.00 per immunization. Cash or check only.
Property Management Company
Provide building employees with flu shot payment receipt suitable for submission to employee insurance.
Seattle Visiting Nurse Association will:
2012 FLU CLINIC REQUEST FORM - PROPERTY MANAGEMENT COMPANY