Prerequisites for Autologous Hematopoietic Progenitor/Stem Cell Transplantation Services

Provided in a Freestanding Clinic If, as part of a hospital-based hematopoietic progenitor/stem cell transplantation program, the hospital intends to provide autologous hematopoietic progenitor/stem cell transplantation services in a separately licensed freestanding clinic, the hospital must have a written, current collaboration agreement with that clinic that describes the responsibilities of each entity. The collaboration agreement shall at a minimum: (1) Describe the services to be provided at the clinic site; (2) Describe the support services available at the hospital site, with particular attention to availability for patient care consultation by all members of the multidisciplinary team, including but not limited to physicians, nurse practitioners, physician’s assistants, nurses, nutritionists, social workers, physical therapists and psychologists; (3) Describe the oversight responsibilities of the hospital; (4) Identify a physician, nurse practitioner, physician’s assistant or nurse coordinator on site at the clinic; (5) Describe the quality assessment and assurance programs for transplantation at the clinic site, with particular attention to how the assessment data is used to improve services and how the data is integrated in the both the clinic’s and the hospital’s quality assurance programs; and (6) Be signed and dated by the Hospital Administrator, Hospital Vice President of Nursing or Clinical Services, Hospital Hematopoietic Progenitor/Stem Cell Transplantation Program Director, Clinic Medical Director and Clinic Physician or Nurse Coordinator.