Agreement to Participation

2019 Mutual Aid Agreement

Our mission is to create a community-wide urgent plan that is a coordinated effort within the continuum of 
care. Our urgent plan will be integrated with community, state, and federal plans. The plan will allow the 
communities access to information, resources, and response to recovery. The plan enables the community 
to move efficiently through various levels of care in the event of an emergency or disaster. 

 

Whereas, both parties desire to assure appropriate continuous care for each of its residents and in 
consideration of the mutual advantages, both parties agree at their own discretion to provide temporary 
housing, nursing care, and other services as deemed necessary. 

 

The transferring facility will provide the necessary medical and administrative information, in compliance 
with HIPAA requirements, so that appropriate care may be provided. All parties agree to comply with 
HIPAA standards and regulations. 

 

The transferring and receiving facility agree to comply with Collaborative Healthcare Urgency Group’s 
Standard Operating Guidelines. 

 

It is understood and agreed that neither the transferring facility nor the receiving facility shall have any 
responsibility or liability whatsoever for any acts of omission during such emergency, disaster of such 
situations. 

 

Receiving Institution 

 

The receiving institution agrees to provide the following, should such a necessity during emergency, 
disaster, or such situations without regard to race, color, creed, national, origin, age, sex, or disability. 

 

1. Respond to CHUG Emergency Operations Center when there is an Activation or Notification of 
an event according to the Message 911 message. 
2. Notify the CHUG EOC of bed availability. 
3. Complete CHUG Patient Triage List (Column 15) and return to the CHUG EOC as designated via 
CHUG. 
4. Accept as many transfers as possible. 
5. Maintain communication with the CHUG Emergency Operations Center (EOC) during and thru 
entire event as designated by the Authority having Jurisdiction or CHUG EOC. 
6. Provide transportation within their capacity to do so. 
7. Provide other medical or nursing services that may be necessary or requested within their capacity 
to do so. 
8. Provide all medical information and/or records as necessary or requested within their capacity to 
do so. 
9. Provide all medical and equipment or staffing as necessary or requested within their capacity to do 
so. 
10. Maintain a current listing of all residents and/or personnel and the disposition of each via CHUG 
SEOG patient tracking list and other documentation. 
11. Maintain a current listing of all transfers made, or discharges, their assigned area sand location. 
12. Maintain a record for all treatment administered, including medical supplies or charges made. 
13. Notify CHUG EOC when patients/residents are received. 
14. Acknowledge All Clear Message. 

 

Transferring Institution 

 

The transferring institution shall agree to provide the following during emergency or disaster or other 
situations, without regard to race, color, creed, national origin, age, sex. Or disability, to the receiving 
institution. 

 

1. Notify CHUG when there is an event that requires sheltering-in-place or possibility of evacuation 
per CHUG Standard Evacuation Operating Guidelines (SEOG). 
2. Notify CHUG EOC of the disaster or emergency. 
3. Maintain communication with the CHUG Emergency Operations Center (EOC) during and thru 
entire event as designated by the Authority having Jurisdiction or CHUG EOC. 
4. Complete CHUG patient Triage List and send to CHUG EOC according to CHUG SEOG 
5. Provide all medical information and/or records as necessary or requested; within their capacity to 
do so. 
6. Provide all medical supplies, equipment and/or staffing as necessary or requested; within their 
capacity to do so. 
7. Provide transportation within their capacity to do so. 
8. Maintain a current listing of all residents and/or personnel and the disposition of each via CHUG 
SEOG patient tracking list and other documentation. 
9. Assign medical personnel as requested. 
10. Notify the attending physicians and patient’s responsible party of the disaster and disposition of 
the patient. 
11. Notify the CHUG EOC when the event is over. 
12. Notify community stakeholders and Partners when the event is over. 
13. Notify the CHUG when residents or personnel can be returned. 
14. Notify CHUG EOC when all residents are evacuated, transported, relocated and received at 
appropriate receiving facility. 
15. Acknowledge All Clear Message 
 

Recovery Process 

 

The transferring and receiving institutions shall agree to provide the following during emergency or 
disaster or other situations, without regard to race, color, creed, national origin, age, sex. Or disability, to 
the receiving institution. 

 

1. Notify the receiving institution of the recovery process after emergency, disaster, or such situation, 
and that transfer arrangements are being made. 
2. Provide all medical information and/or records as necessary or requested within their capacity to 
do so. 
3. Provide transportation within their capacity to do so. 
4. Maintain a current listing of all residents and/or personnel and the disposition of each transfer. 
5. Notify the attending physicians and patient’s responsible party of the recovery process and 
disposition of the patient. 
6. Notify the receiving institution when the emergency, disaster, or other such situations are over. 
7. Notify the receiving institution when residents or personnel can be returned. 
8. Notify CHUG EOC when all residents are transferred back to receiving facilities. 


 

Nothing in this agreement should alter the freedom exercised of either facility or affect in any way, the 
independent operation of either facility. 

 

If the emergency, disaster, or such event exceeds the duration of a routine billing day, charges for services 
performed by one party of patients transferred from the other party pursuant to this agreement shall be 
collected by the party rendering such services directly from the patient or from other sources normally 
billed. 


When all patients are returned to the transferring facility, all financial arrangements shall cease from the

receiving facility, and be re-instituted by the transferring facility. 

 

Hospitals will discharge the patients from their respective facilities and the receiving facilities shall begin

billing effective the date of transfer. 

 

Transportation Organizations 

 

The transportation organizations shall agree to provide the following during emergency or disaster or

other situations, without regard to race, color, creed, national origin, age, sex. Or disability, to assist

CHUG in the evacuation, transport, and relocation of residents and patients from a stricken facility

to the receiving facility. 

 

1. Respond to Activation and Notification from the CHUG EOC Message 911 system. 
2. Assist with the evacuation and transport from the stricken facility based on notification from CHUG 
3. Complete CHUG Patient Resident Triage List (Column 16) appropriate transportation vehicle

according to patent/resident medical needs. 
4. Transport residents and patients to the Receiving Facilities. 
5. Maintain appropriate transportation level of care for resident/patient. 
6. Maintain communication with the CHUG Emergency Operations Center (EOC) during and thru entire event as 
designated by the Authority having Jurisdiction or CHUG EOC. 
7. Provide Transportation Liaison to the CHUG EOC and/or Stricken facility during event. 
8. Notify CHUG of designated Transportation Liaison 
9. Maintain a current listing of all transfers made and their assigned areas and location. 
10. Maintain a record for all treatment administered, including medical supplies or charges made. 
11. Transportation charges should be standard fees and be charged to the patient/residents insurance

provider or the stricken facility. 
12. Maintain all CHUG documentation records and/or internal records in the event of an audit, insurance or 
declaration of disaster. 
13. Transportation back to stricken facility from the receiving facility will be coordinated via the stricken facility. 
14. Acknowledge All Clear Message. 


This agreement shall continue in effect indefinitely, except that either party amend any portion therefore,

or may terminate such agreement by giving a sixty (60) day notice to the other party of its intentions.

If such notice is for termination, this agreement shall be automatically terminated at the expiration of

the sixty (60) days’ notice. 

 

This agreement shall become null and void if either institution’s license has been revoked, or if there

has been a change of ownership. 

 

 

 

© 2019 by Collaborative Healthcare Urgency Group (CHUG)