Services Agreement

Client Name(Required)

Effective Date(Required)

Service Selection(Required)

Vaccine Clinics (Flu, COVID-19, Shingles, RSV, etc.)

Drug Screening (DOT and non-DOT)

Breath Alcohol Screening (DOT and non-DOT)

Physical Exams (DOT and non-DOT)

Rapid Testing (COVID, Flu, RSV)

Biometric Screenings

Billing Information (if different from above)

Billing Address/City/State/Zip

Contact

Phone

Fax

Who would you like to receive the results?

Drug Screen Results

Recipient Name(Required)

Phone(Required)

Secure Fax

Secure Email

Physical Exam Results

Recipient Name(Required)

Phone(Required)

Secure Fax

Secure Email

APPENDIX A – VACCINE CLINIC SERVICES

Vaccines Offered: Flu (standard and high-dose), COVID-19 (Comirnaty/SpikeVax), Shingles (Shingrix), RSV (Abrysvo), Hepatitis B, TDAP.

When signing the agreement, parties agree to the following:

Logistics: Prior to signing this agreement, Client will provide details about their health insurance plan to allow ABH to verify the Client is in network.

Definition of Clinic:
- a.) A clinic begins at the time the Client requests it start until the last vaccine is administered.
- b.) For clinics over three hours, the Client will be charged an extended onsite fee per additional hour.
Hours of Services: AirBioHealth’s standard vaccine service hours are 7:00am to 5:00pm, Monday through Friday
Scheduling: ABH will use an online scheduler such as SignUpGenius
Travel: Requests for clinics more than a 50-mile radius from ABH will be considered for approval with additional quoted travel fees based upon the unique needs of the situation.
Set-up and Take-down:
- a.) 30 minutes prior
- b.) 30 minutes after
Supplies: ABH will provide all medical supplies necessary to conduct the clinic.
- a.) Vaccines supplied to ABH by our distribution and billing partner – Vaxcare.
- b.) Disclaimer: In the event of a nationwide vaccine shortage, or inability of our distribution partner to obtain vaccine, ABH will not be held liable. In the event this occurs we will communicate such with your time in a timely manner.
Insurance verification: Client will provide a group member listing if vaccines are to be billed to their health insurance plan.
Consent Form: Each participant will be required to review and sign a consent form prior to receiving services.
Vaccine Clinic Setting: Client agrees to provide a safe and clean environment, and will provide tables, chairs, trash cans, wireless internet access and any other furnishings required.
Crowd Control: ABH is not responsible for crowd control or security.

Minimums: Client will be charged the greater of participant minimum (15) or the number of actual participants.

Cancellation and Rescheduling:

Canceling or rescheduling a clinic less than 7 business days prior to the event for reasons other than Force Majeure Event, Client will incur a cancellation fee.
Cancellation notices to be communicated with ABH contact noted above.

Reporting: After vaccination clinic, ABH will provide a report of the number of participants and services provided.

Payment:

Direct pay by Client: Client will be responsible for payment of fees related to onsite fees, travel expenses, and associated administrative fees not covered by health insurance payer
Claims Billing: ABH partners with Vaxcare for billing to third party payers covered by employers’ health insurance plan. (In the event, third party payer does not reimburse Vaxcare for vaccine cost, or administration fees, the client will be responsible)

APPENDIX B – DRUG & ALCOHOL SCREENING

AirBioHealth will provide collection and testing of urine samples for the purpose of screening the Client’s employees for the presence of illegal drugs in their system. All tests will follow the Department of Transportation (DOT) protocol. The client agrees to provide AirBioHealth with the name and contact information of the Designated Employer Representative (DER) at the company, and a secondary DER, if the main DER cannot be reached. Federal Rules require that Service Agents like AirBioHealth have the name/contact information of a DER at the company who may be reached at all hours that screening may be conducted.

Clients that require the non-DOT collection, AirBioHealth will provide a 5 to 12-panel urine screen based on the client’s drug policy. Negative results will be screened within 24 business hours and non-negative results will be analyzed and reported by our MRO within 2-5 business days.

Laboratory Analysis: All samples, unless otherwise arranged, will be tested by a Substance Abuse and Mental Services Health Administration (SAMSHA) approved and regulated laboratory. Samples will be picked up daily by laboratory courier or other approved carrier (and may include FedEx and/or UPS). Negative results are typically available within 24 hours, and positive results will be returned following Medical Review Officer (MRO) review per DOT protocol, which will take an additional 2-5 days. The laboratory will store all positive samples for a period of one year.

Note: All Department of Transportation (DOT) urine samples must be tested by SAMSHA-approved laboratories only.

Confirmation of a Positive Result: The Client agrees that all potential positive drug test results will be reviewed by the MRO, with follow-up contact made with the donor. The purpose of this follow-up interview is to determine the presence of legal medications. Confirmation will be made with the prescribing physician prior to clearing a positive result.

Reporting: Negative results will be communicated to the Client by fax, or email, Positive results require review by MRO, which can take an additional 2-5 days. Positive results will be communicated by telephone to the Client approved representative as soon as confirmed, with written confirmation by fax, or email.

AirBioHealth Policy on Medical Marijuana: Use of “medical marijuana” is not grounds for a negative test result per DOT Federal Rules. The Client agrees to abide by all positive result reports from the MRO for marijuana, regardless of claims of medical marijuana use. Unless your Company Policy states otherwise, we will follow all DOT guidelines even on non-DOT specimens. Additionally, we do not accept medical marijuana as a valid reason for a positive test. The Client may choose to override the AirBioHealth medical marijuana policy by stating in their company policies that a positive for this test is acceptable.

AirBioHealth Policy on Prescription Medications: It is the AirBioHealth policy that should a donor test positive for a metabolite and have in their possession a valid prescription from a medical doctor, that our MRO can confirm with a pharmacy, this information will be reported as a negative. However, if the prescription is not legally valid according to Rules or Regulations or is not in the donor’s name, this information will be reported as a positive.

Collection Protocol: All collections, unless accepted by the conditions listed for observed collections below, will afford the donor full privacy and dignity. All services will be provided at the Client’s office, Client facilities, Client-designated locations, or at an AirBioHealth clinic, as requested by the Client. The collection protocol for standard urine collection follows all DOT guidelines. This protocol will be provided to the client, that can be posted in the collection facility for the donor’s information.

Observed collections are required by the DOT under certain circumstances and we abide by these rules. Causes for observed collections: tampered sample, out-of-range temperature, the donor brings items to the collection site that are meant to adulterate or substitute the sample, the MRO ordering a collection under direct observation, and whenever the collection is for a Return-to-Duty or Follow-Up Test. See CFR part 40.67. For non-DOT collections, the client may request that we conduct direct observations under the following conditions and only in accordance with applicable laws. Non-DOT direct observation collections are permitted only under the following conditions:

Written protocol with the Client that includes written disclosure to the employee that is acknowledged by donor signature.
The Client representative will be contacted for concurrence prior to the collection.
The donor will not be permitted to leave the collection site until the collection is complete. If the donor chooses to leave before the collection is complete, it is considered a refusal to test.
An observer of the same gender will always be used.
Causes for observed collections are adulterated sample, out-of-range temperature, Client request in writing due to suspected adulterations of previous samples, or that the Client suspects an attempt will be made to adulterate the current sample.

Alcohol Testing: Our facility follows the DOT/Federal protocol for all Regulated alcohol tests. This includes a Screening Test performed by a trained alcohol testing technician following the 49 CFR Part 40 Rules. If the screening test is “positive” (0.02% or higher), Federal Regulations require a 15-minute waiting period and then a Confirmation Test. When possible, we also follow a positive Confirmation Test with an accuracy/calibration check using an NHTSA-approved Standard (such as a compressed alcohol gas tank following the device manufacturer’s Quality Assurance Plan).

For non-Regulated alcohol tests, we will follow the DOT/Federal protocol unless you/the client notifies us that your company policy protocol specifies a deviation from the Federally accepted process. Please provide us with a copy of your full Company Drug & Alcohol Testing Policy so that we may follow any specific procedures that you may have.

**Cancellation of Dispatch Fee: Once the tech has confirmed he/she is in route and provides an ETA, then if services are cancelled between dispatch and arrival - the company will be charged the cancellation fee.**

APPENDIX C – PHYSICAL EXAMS

Location	Services	Hours
Clinic Location (AirBioHealth) 1714 Charlestown New Albany Rd, Jeffersonville, IN 47130	DOT Physical Non-DOT Physical Lift Test Childcare Physical	Monday–Friday: 9:00 am–5:00 pm Saturday–Sunday: CLOSED
Onsite Location (Location provided by client)	Onsite Fee (up to 3 hours) Extended Onsite Fee per additional hour Travel Fee (over 50 miles from ABH): Quoted Cancellation Fee (less than 7 days prior)	Monday–Friday: 9:00 am–5:00 pm (During ABH business hours)

*Lift Test - Fee determined by requirements of test.

APPENDIX D – RAPID TESTING & BIOMETRIC TESTING & SCREENING FEES

Additional Services can be provided on-site or at AirBioHealth (cash only):

COVID Test - Rapid
FLU Rapid - Rapid
COVID/FLU Combo - Rapid
TB Skin Test
Quantiferon
Biometric Screening*

(please call to discuss what may be covered by group insurance)

*All services listed above are conducted at AirBioHealth (1714 Charlestown New Albany Rd, Jeffersonville, IN 47130) except the biometric screening which is done onsite

Reporting: Within 24–48 hours depending on test type and processing lab

This Services Agreement (“Agreement”) is entered into by and between AirBioHealth LLC (“ABH”), an Indiana company, and the undersigned client (“Client”). The Client agrees to the following terms and conditions, and to the selected services outlined below.

Quality Assurance:

AirBioHealth is committed to maintaining the highest standards of proficiency, training, and compliance across all services provided. We ensure that our staff members are properly trained, certified, and qualified in accordance with all applicable regulations and industry standards. Training records and certifications are available to Clients upon request. AirBioHealth adheres to all relevant regulatory requirements and ethical standards to deliver high-quality, reliable services to our customers.

Payment Terms: The client agrees to make payment in full within thirty (30) days of the billing statement.
Billing options are ACH, PayPal, Credit card (over the phone with a 4% manual card entry fee)or mail a check to:

AirBioHealth
1714 Charlestown New Albany Rd
Jeffersonville, IN 47130

Term of Agreement: Either party can terminate this Agreement with written (by email, or mail) notice, with or without cause.

Service Fees: Fees for each service type are outlined in the applicable appendix and may include: standard rates, after-hours surcharges, onsite fees, claims administration fees, wait time charges, and/or travel or cancellation fees.

Confidentiality: AirBioHealth maintains strict confidentiality in handling all client and individual health information. We adhere to all applicable confidentiality and privacy standards, including but not limited to HIPAA, DOT regulations, and other relevant federal, state, and industry-specific requirements. Information will only be disclosed to authorized parties, such as designated employer representatives, Medical Review Officers (MROs), laboratories, or as required by law, formal written consent, or court order.

Indemnification: By signing this Agreement, the Client acknowledges and agrees to the utilization of AirBioHealth services per the DOT/DHHS/AirBioHealth protocol and agrees to hold harmless AirBioHealth from all claims, including but not limited to losses, damages, injuries to persons, or act of negligence, arising out of AirBioHealth use of said procedures on behalf of the Client. However, no indemnification or hold harmless shall apply to AirBioHealth own negligence in not reasonably following said procedures/protocols for employer health services as such may be amended from time to time. When required, the Client agrees to follow all Federal, DOT, and State Regulations relating to services rendered.

Arbitration Clauses: In the event, a dispute arises between the parties as to the duties or compensation under this Agreement, such dispute shall be submitted for arbitration under the then-existing rules established by the American Arbitration Association.

Attorney’s Fees: If any contested action is brought to enforce, modify, interpret, or void the provisions of this Agreement, then the prevailing party shall be entitled to reasonable attorneys’ fees as well as appropriate relief.

Entire Agreement: This Agreement constitutes the entire Agreement between the Parties with respect to Services and supersedes all prior agreements and understandings within terms and conditions. This Agreement may not be amended or modified in any respect except by an agreement in writing executed by both Parties.

Severability: In the event that any of the provisions of this Agreement are deemed invalid or unenforceable, the remaining provisions shall be construed and enforced as if the invalid or unenforceable provisions were.

Waiver of Breach: Non-action by any Party in response to a breach of any provision of this Agreement shall not operate or be construed as a waiver of any rights hereunder or acceptance of any subsequent breach of any provision of this Agreement. Any waiver must be in writing and signed by the applicable Party.

Change of Information: Each Party agrees to notify the other, in writing, of any changes in address, hours of service, phone number, or other contact information. The undersigned understands and agrees to the terms and services outlined in this agreement.

Company Information