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HomeMy WebLinkAboutIL204 Interlocal Agreement Memorandum of Agreement By and Between: Northwest Regional Council Skagit Office: 1650 Port Drive Burlington, WA 98233 Phone: 360-428-1301 Fax: 360-428-1302 Whatcom Office: 600 Lakeway Drive, Ste 100 Bellingham, WA 98225 Phone: 360-676-6749 And Anacortes Fire Department 1016 13th Street Anacortes, WA 98221 360. 293-1925 360. 299-1965 Effective: February 1, 2015 through December 31, 2016 Northwest Regional Council-Skagit County Fire-EMS Providers Memorandum Of Agreement February 1, 2015 — December 31, 2016 I. Purpose The purpose of this Memorandum of Agreement is to formalize a coordinated partnership between Northwest Regional Council (NWRC) and ,nacortes Fire Department In the course of their regular business of responding to emergent calls in the community, the Anacortes Fire Department may encounter people that may benefit by receiving additional services and supports through NWRC. NWRC is experienced in providing people with information and assisting them with access to long term services and supports. NWRC also coordinates with other community organizations to meet the needs of the seniors and people with disabilities served by the agency. Anacortes Fire Departmem and NWRC will coordinate to implement the Community Response and Support program that includes a formal referral process for people needing long term service and supports in Skagit County. II. Organizational Overviews The Northwest Regional Council (NWRC) is Northwest Washington's Area Agency on Aging serving people of Whatcom, Skagit, Island, and San Juan Counties. NWRC implements state and federal programs for seniors and people who need long term services and supports. Some of the community-based care available through NWRC are Aging and Disability Resources, Congregate Meals, Meals on Wheels, Respite Care, Adult Day Services, Case Management, and Family Caregiver Support. Anacortes Fire Denartmenr provides fire and emergency medical response to the citizens of Skagit County. They take pride in their rapid response times and continuously strive to improve services they provide to the community. Anacortes Fire Departmei is often the first and sometimes the only contact for seniors and people with disabilities who are isolated in their homes. Ill. Responsibility of the Parties • When providing emergency response to the community, Anacortes Fire Denartmen` will identify patients/clients that may benefit from a follow up call from NWRC. The first responders will talk to the patient and ask them to sign a patient referral form allowing them to refer to and share information with NWRC. • Anacortes Fire Departmen and NWRC will train all Fire/EMS responders in their service area on things to watch for when responding and on the Patient Referral protocols. Memorandum of Agreement NWRC and Skagit County Fire-EMS providers Northwest Regional Council-Skagit County Fire-EMS Providers Memorandum Of Agreement February 1, 2015 — December 31, 2016 • Patient referrals will be faxed to 360-428-1302 to the attention of Aging and Disability Resources (ADR) at the Skagit Office of Northwest Regional Council. • NWRC's Aging and Disability Resources (ADR) will receive the referrals from the Anacorfi-3 Depalfi°nen . NWRC's ADR staff will contact the patient/client, talk with them about their needs, educate them on available resources, and assist them with accessing resources. • NWRC will coordinate with volunteers or other community partners to conduct home assessments when needed. • Anacortes Fire Department and NWRC will work together to determine what data will be most beneficial to collect and what method will be the most effective way to track the data. • Both Anacortes Fire Department and NWRC will educate stakeholders as to the need and results of the program. IV. Confidentiality Agreements • Each party acknowledges its obligations under this MOA may involve the receipt of protected personal health information. The parties agree to the following in relation to such information: • Anacortes Fire Department will have patient sign a patient referral form and will include a signed copy as part of the referral. Verbal consent is acceptable, if documented. • Anacortes Fire Department and NWRC agree not to use the patient/client information for any other reason than to provide Community Resource and Support interventions. • Both parties agree not to disclose confidential patient/client information unless they receive written authorization from the patient/client. • Both parties will take all reasonable precautions to prevent unauthorized physical and /or electronic access to confidential patient/client data. Memorandum of Agreement NWRC and Skagit County Fire-EMS providers Northwest Regional Council-Skagit County Fire-EMS Providers Memorandum Of Agreement February 1, 2015 — December 31, 2016 Witness whereof, the parties hereto have caused this Memorandum of Agreement to be executed by their duly authorized representatives. ‘39A Signature of Northwe R ional Council Date Dan Murphy, Execu e Dector 360-676-6749 MurphDK@dshs.wa.gov e)e, Signa ure of City o Anacortes Date Name Phone Memorandum of Agreement NWRC and Skagit County Fire-EMS providers