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Home My Public Portal AboutNorthwest Florida Psychological Servicesr Contract for Service Psychological Services between Crestview Police Department And Northwest Florida Psychological Services, P.A. AGREEMENT: Northwest Florida Psychological Services, P.A. will provide psychological services for staff or potential staff referred by Crestview Police Department under the terms of this agreement. PURPOSE: Northwest Florida Psychological Services, P.A. will provide Fitness for Duty Evaluations and Pre -Employment Assessments for the Crestview Police Department's staff or potential staff, when needed, to address psychological issues. It is Northwest Florida Psychological Services' intent in this agreement to form a working partnership, outlining in simple terms what we will provide for your organization, permitting you have such a program in place for your staff or potential staff at the time of their individual need for service. It is our desire that this program be cost effective for you and flexible for both of us. TERMS: The period of this agreement is for 12 months from the date both parties sign this contract. PSYCHOLOGICAL SERVICES AGREEMENT 1. REFERRAL FOR SERVICES: Staff or potential staff will be referred by the Chief of Police or his/her designee by calling Northwest Florida Psychological Services' office manager for scheduling at (850) 200-4379. Staff will discuss the circumstances of the referral, handle appointment arrangements and provide timely follow-through. The staff or potential staff may directly contact Northwest Florida Psychological Services at (850) 200-4379 after being referred by Crestview Police Department. Northwest Florida Psychological Services staff will discuss the circumstances of the referral, handle appointment arrangements and provide timely follow-through. 2. ADMINISTRATION AND COORDINATION: This agreement will be administered through Northwest Florida Psychological Services for all staff or potential staff of Crestview Police Department. Applicants will have their packet filled in prior to the appointment. Crestview Police Department will approve all invoices for payment. Evaluations will be conducted at: Northwest Florida Psychological Services located at 151 Mary Esther Boulevar Mary Esther, Florida 32569; telephone number (850) 226-7322 or 535 S. Ferdon Boulevard, Suite B, Crestview, Florida 32536. 3. FEE FOR SERVICES: Each service will be billed to Crestview Police F Crestview Police Department will be charged $40 for a no show. .* Pre -employment screenings administered through Northwest Florida Psychological Services for sworn/auxiliary/reserves staff or potential staff of Crestview Police Department includes a standard battery (one measure of personality functioning, assessment of mood, and screening for psychotic symptoms), clinical interview and mental status evaluation for $200.00. Post -offer evaluation: If a Level II assessment for special issues (ex: personality, ADHD, IQ) is requested by CVPD following the initial pre -employment assessment, the additional fee is billed at $300.00 per post -offer evaluation. The Level II will assess one additional issue specified using any of the following instruments: a full scale intelligence test, a memory test (WMS-IV), two tests of attention/concentration or an additional personality inventory (MCMI-III, MMPI-2 or PAI). This service is offered and is optional to Crestview Police Department. Fitness for Duty will incorporate psychological testing and an interview for each referral at a flat rate fee of $600.00 for this service conducted through Northwest Florida Psychological Services for all staff of Crestview Police Department who have previously completed pre- employment screenings at Northwest Florida Psychological Services. Fitness for Duty evaluations will be conducted for a flat rate of $650 for employees who have never been screened by Northwest Florida Psychological Services. 4. CONFIDENTIALITY: Due to professional practices and confidentiality laws, a release form, signed by the Crestview Police Department staff or potential staff is needed before Northwest Florida Psychological Services can subsequently speak with the client organization about individual cases. In the case of referral by the client organization, a release will be requested of the Crestview Police Department staff or potential staff at the time they meet with the Northwest Florida Psychological Services provider. 5. Crestview Police Department agrees to sign and abide by the conditions set forth in the Contract for Services in regard to compliance with terms of the Health Insurance Portability and Accountability Act (HIPAA). This HIPAA Agreement will remain in effect as long as there are active contracts between Crestview Police Department and Northwest Florida Psychological Services. Under Florida Law, all contracts with the Crestview Police Department are subject to disclosure as a public records request pursuant to Chapter 119, Florida Statutes. If contractor receives a public records request made pursuant to Chapter 119, Florida Statutes, contractor hereby agrees to contact the Crestview Police Department immediately upon receipt of the request for review for confidential and/or exempt information prior to the release of the record(s). AGREEMENT: We, the undersigned, agree toe provisions of his Crestview Police Department Psychological Services Agreement, this day of Tony R. Taylor Chief of Police Crestview Police Department 4111/(a-ka 120) Julie F. Harper, PsyD. Licensed Psychologist Owner of Northwest Florida Psychological Services, P.A. , 2016.