MOU AGREEMENT FOR MEDICAL ADVISOR SERVICES FOR THE SAUK COUNTY DEPT. OF PUBLIC HEALTH

AGREEMENT FOR MEDICAL ADVISOR SERVICES
FOR THE SAUK COUNTY DEPARTMENT OF PUBLIC HEALTH

THIS  AGREEMENT  FOR  MEDICAL  ADVISOR  SERVICES  FOR THE SAUK  COUNTY
DEPARTMENT OF PUBLIC HEALTH (the "Agreement") is entered into as of February I, 2023, with an 
effective date of March I, 2023 (the "Effective Date") by and between Amy DeLong, MD ("Physician") 
and the Sauk County (the "County") Department of Public Health ("SCPH"). The Physician and SCPH may 
be referred to singularly as a "Party" or collectively as the "Parties".
The Parties agree that this Agreement will continue for one (I) year following the Effective Date, 
but is renewable for successive one-year terms thereafter with the mutual consent of both Parties. 
The Agreement may be terminated by either Party with 60 days' written notice to the other Party.
SCPH hereby appoints Dr. Amy DeLong to serve as the Medical Advisor ofSCPH. Both Parties agree to 
the following:

I. I   Physician shall serve in an uncompensated, voluntary position.
1.2   Nothing in this Agreement shall limit or restrict the Physician's right to serve as medical 
advisor, or in any other capacity, within another Public Health Department or other entity.
1.3    Medical advisors provide formal delegation of medical acts to licensed professional nurses, 
licensed practical nurses, and lesser skilled assistants where required by Wisconsin Statute, 
Chapter 448, Medical Practices, and Wisconsin Statute, Chapter 441, Board of Nursing.
I .4   Such physicians shall become state agents of the Wisconsin Department of Health Services for 
the purposes of Wisconsin Statutes s. 165.25 (6), s. 893.82 (3), ands. 895.46 for the services they 
provide for the programs and services of the SCPH that require medical oversight. The designation 
of state agent status authorizes the State to provide legal representation to the volunteer medical 
advisor and to indemnify him or her from liability arising from the medical advisor's performance 
of duties. SCPH and the County does not undertake any obligation to indemnify or hold harmless 
Physician, or any other third party, as part of the obligations agreed to by SCPH and/or the County 
in this Agreement.
1.5  Role, responsibilities, duties, and expectations include:
•  Develop and authorize medical orders for delegated functions (as detailed Wis. Admin. Code Ch. N 
6.03(2) Performance of Delegated Medical Acts) to professional nurses, licensed practical nurses, 
and lesser skilled assistants employed by the local health department.
• Provide consultation, technical assistance, training, and medical advice to the Director/Local 
Health Officer as set forth in Wis. Stat. § 25 I .06the SCPH and its staff, and the County Board of 
Health for the required public health services of communicable diseases surveillance, prevention 
and control; human health hazard control; the development of health promotion and disease 
prevention programs, including public health nursing programs and services.
•  Serve as a liaison in building effective partnerships between SCPH and local medical and health 
care providers to protect the health and safety of the community.
•  Review specific clinical policies and procedures for the SCPH when requested.
2.    Physician represents and warrants to SCPH that they:
•  Are and shall at all times during the term of this Agreement remain duly licensed and registered 
and in good standing under the laws of the State of Wisconsin to engage in the practice of medicine 
and that said licenses and registrations have not been suspended, revoked or restricted in any 
manner;
•  Are not currently under investigation for nor has s/he been convicted of any offense related to 
the delivery of a health care item or service under any state or federal or private health care 
benefit program;
•  Have not been required to pay any civil monetary penalty regarding false, fraudulent, or 
impermissible claims under, or payments to induce a reduction or limitation of health care services 
to beneficiaries of, any state, federal, or private health care benefit program;
•  Have not been excluded from participation in any state, federal or private health care
benefit program.
• This Agreement shall be governed by the laws of the State of Wisconsin.