Hemodialysis Practice Agreement
Article 1 – Parties
1.1. Institution:
Title: ………………………………… (☐ SGK Provincial Directorate / ☐ SSK Presidency General Directorate of Health Affairs ……………… Hospital Chief Physician's Office)
Address: …………………………………
Tax Number/MERSIS: ……………………
Note: After Law No. 5510, SSK SGK. The institution title will be written according to the current organizational structure.
1.2. Center (Hemodialysis Healthcare Provider):
Title: …………………………………
License No. (Dialysis Center Opening Permit): ………………
Address: …………………………………
Tax No./MERSIS: …………………
Authorized representative(s): Name-Surname/Title
Signature Circular Date-Journal Entry: …………
1.3. The Parties will be referred to collectively as “the Parties”.
Article 2 – Subject of the Agreement
2.1. The subject of this agreement is the provision of hemodialysis (acetate/bicarbonate) and related examinations/treatments and sub-services, included in the "Health Services Purchased by the Institution Fee Tariff" (hereinafter referred as " Tariff ") , to patients who apply to the Center with a referral from the Institution, in accordance with this agreement, its annexes, and current legislation. 2.2. The sub-services included in the scope are listed in Annex-1 (package contents including medication/consumables, transportation, consultation, emergency intervention, etc.).
Article 3 – Definitions
3.1. Institution: SGK (Social Security Institution) and/or authorized health facilities under Law No. 5510.
3.2. Center: Licensed hemodialysis provider.
3.3. Patient/Beneficiary: Individuals receiving health benefits under Law No. 5510, Law No. 2925, and relevant international social security agreements, and their dependents; also, beneficiaries during unemployment benefit periods (within the framework of the law).
3.4. Referral Document: A document issued by the Institution indicating the scope and limits of the service.
3.5. Tariff: The Institution's fee schedule in effect for the relevant period.
3.6. (KVKK): Law No. 6698 and secondary legislation related to health data.
Article 4 – General Administrative Provisions
4.1. Acceptance of Referred Patients : The examination/treatment of patients properly referred by the Institution's health facilities is carried out by the Center. 4.2. Participation in Boards : The Center's authorized physician participates in local health boards upon invitation. 4.3. Institution's Right to Inspect : The Institution has the right to inspect the quality, quantity, and nature of the service at all times. If necessary, it may commission external expert examinations. Any damages to the Institution due to fault/defect attributed to the Center, as well as expert examination expenses, are covered by the Center. 4.4. Suspension : The Institution may temporarily suspend patient referrals and contract execution for justifiable reasons . 4.5. Record Keeping and Reporting : The Center maintains daily data records , morbidity-mortality rates, session and complication records, etc., using the Hospital Information System/Obstetrics System; these records are continuously accessible to the Institution . 4.6. Provision of Documents : Upon request from the Institution, copies of patient files/reports/films and digital records are provided unconditionally and free of charge . Termination may be applied if delivery is prevented/avoided (see Article 11). 4.7. Prohibition of Additional Fees : No additional fees (including donations) may be requested from patients referred by the institution (except at the patient's own request ) . 4.8. Absence of Procedures Without Referral : No payment will be made to patients without a referral. Payment will also not be made for procedures outside the scope of referrals. 4.9. Out-of-Coverage Recommendations : Non-urgent, out-of-coverage recommendations are reported to the referring facility with a reasoned report ; they cannot be performed without an additional referral . 4.10. After-Hours Operations : Procedures can be performed after working hours/weekends/holidays with a temporary referral form and the approval of the on-duty chief/physician; the guarantee/promissory note will be returned when an official referral is subsequently provided. 4.11. Preparation-Declaration : The Center provides a written commitment for after-hours service ; it makes the necessary manpower/equipment/logistics planning. 4.12. Alternative Provision : If the Center cannot provide the service, the Institution will provide the service through other channels; The costs are deducted from the Center's receivables or collected through legal means . 4.13. Authorization Documents : The power of attorney and notarized signature circular of the authorized person , and if it is a legal entity, current trade registry documents are attached. 4.14. Case Selection : The Center cannot select cases. The medical/logistical reason for refusal must be reported in writing immediately in the emergency room , or within … hours if it is not an emergency . If the Institution deems it insufficient, it will recoup the expenses from the Center. 4.15. Fault-Responsibility : Compensation (material-moral) finalized by court decision is paid by the Center to the Institution with bank rediscount interest . 4.16. Social Security Notifications : Employees' SGK (Social Security Institution) records and statements of no premium debt are submitted with the invoice every 4 months ; no payment is made until the debt is settled. 4.17. Assignment of Receivables : The Center's receivables from the Institution cannot be transferred/assigned . 4.18. Conflict/Interest : In accordance with Law No. 657 and related legislation, no prohibited partnerships/employments can be made with Institution/Ministry employees; a commitment letter must be provided. 4.19. Taxes : VAT and other taxes are paid by the Center; Stamp Duty is paid to the Institution's cashier and the receipt is kept in the file. 4.20. Tariff Change – Interim Period : If approval is given to continue dispatches with a commitment letter until the new period's fees/conditions are announced, payment will be made according to the new tariff. This period does not count as a contract renewal commitment . 4.21. Forgery and Irregularities : In cases of document/invoice falsification, excessive invoicing, writing down unused services/materials, etc., termination and prohibition of fixed-term contracts will be applied (Article 11). 4.22. Critical Personnel – Equipment Change : Departure of the responsible physician/specialist, equipment/title change must be reported to the Institution within … hours/days ; … days are given for new personnel ; an additional … days for documents . 4.23. Address Change : The relocation date must be notified … days in advance ; referrals are suspended . Referrals will resume after the Ministry of Health's suitability letter and status assessment report (… days) at the new location; termination if the deadlines are exceeded . 4.24. Number of Physicians : It is mandatory to have a sufficient number of authorized physicians throughout the service period . 4.25. Inadequate Service : Procedures found inadequate by the institution's physician will be repeated free of charge ; if refused, the institution will provide the service through another means and collect the cost from the Center. If there are 3 reports of inadequacy in the same period, the report will be submitted to the institution's center. 4.26. Prohibition of Referral : The Center cannot provide any incentives/benefits related to referral/content referral in any way .
Article 5 – Specific Administrative Provisions (Dialysis)
5.1. Working Procedure of the Responsible Physician : The responsible physician works full-time ; two/three part-time physicians cannot be accepted in their place . 5.2. Leave/Absence : During the responsible physician's leave, a substitute physician, deemed suitable and meeting the conditions by the Provincial Health Directorate, will be notified; the responsible specialist and the responsible physician cannot be on leave at the same time . 5.3. Departure of the Responsible Specialist : Except in cases of necessity, departure must be reported to the Institution at least … days in advance; application documents for a new specialist must be submitted. In case of a necessary departure, a temporary specialist with … months of qualifications will be appointed. 5.4. Laboratory Contract : A separate laboratory contract (Medical Tests-Analysis in Hemodialysis Applications) is required for necessary tests ; otherwise, they will be provided from the Institution's facilities with the Institution's approval. 5.5. Use of External Units : No procedures can be performed in external units/other centers without the knowledge and approval of the Institution.
Article 6 – Technical-Medical Provisions
6.1. Session Parameters : Acetate/bicarbonate dialysis is applied according to the weekly number of sessions specified in the referral form, with a minimum session duration of … hours . 6.2. Admission and Transfer : Patients requiring it may be admitted to the Institution's facility and sent to the Center for dialysis. 6.3. Adequacy Monitoring : In regularly treated patients, adequacy is assessed monthly with Kt/V, urea kinetics, etc.; the dialyzer and duration are adjusted. 6.4. Water System : Chemical and microbiological controls of pure water are performed every … months in a public laboratory ; reports are submitted during inspections. 6.5. Mandatory Test Schedule :
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Monthly: Urea/BUN, creatinine, ALP, Na, K, Ca, P, uric acid, Mg (optional), complete blood count, AST/ALT, bilirubin, glucose, total protein-albumin, urinalysis.
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Two Months: Hepatitis markers (HBsAg, Anti-HBs, Anti-HCV; ELISA mandatory), serum iron, total blood sugar level, ferritin.
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Six Months: PTH, lipids (total cholesterol, triglycerides), chest X-ray, ECG, CMV, HIV.
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Annual: Bone X-rays, if needed.
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Before starting dialysis: Hepatitis and HIV screening.
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Urgent/Justified : Additional tests deemed appropriate by the responsible physician (with a justified report). 6.6. Record Keeping : All interventions, tests, medications, and reports are recorded completely on the Hemodialysis Follow-up Form ; the form is obtained from the Institution. 6.7. Anti-HCV Organization : Anti-HCV (+) patients are dialyzed in a separate room with separate machines; this is indicated by a chart; the nurse serving these patients does not serve negative patients on the same day . 6.8. Erythropoietin (EPO) Administration : Initial criteria, dose (initial 50–150 IU/kg/week; maintenance 50–125 IU/kg/week, 2–3 doses per week), targets (Hb 10–11 g/dl; Htc ≤ 33%), contraindications , response assessment (week 8), and follow-up record application are detailed in Appendix 2. Weight (dry weight) and blood test results are mandatory during the prescription approval process. The procedure is performed subcutaneously .
Article 7 – Billing, Fees and Payment Terms
7.1. Tariff : Payments are made according to the tariff ; VAT is not included . 7.2. Basis Date : The fees on the shipping date are used as the basis for the invoice. 7.3. Report Submission : A copy of the examination/result reports is attached to the shipping document; no payment will be made for procedures that do not include a copy. 7.4. Invoice Schedule : Invoices cover a monthly period (1-last day) ; they are submitted to the Institution by … days of the following month along with the relevant documents. Invoices not submitted within the first … days are considered submitted on the first day of the following month . 7.5. Review Period : A review is conducted within … days of entry into the Institution's records , and the appropriate amount is paid. For invoices found to be inappropriate/incomplete, a notification is made within … days , and they are returned; the review period restarts after an explanation is received . 7.6. Medications/Consumables : Medications/consumables included in the package are covered by the Center; no additional payment is made. Items not covered within the package are deducted from the invoice . 7.7. Irregularities : In case of detection of numerical manipulation/forgery, etc., the provisions of Article 11 shall apply.
Article 8 – Information Security, Personal Data Protection Law (KVKK), and Medical Records
8.1. Confidentiality: The center and its personnel protect patient personal data and trade secrets in accordance with the Personal Data Protection Law (KVKK) and health legislation.
8.2. Information/Consent: An information text is provided, and explicit consent is obtained when necessary; data minimization and access authorization records are maintained.
8.3. Data Sharing: Data shared with the institution under mandatory sharing only for the purpose ; a legal basis is sought for transfers to third parties.
8.4. Storage: Medical records are stored in accordance with legal timeframes; a destruction policy is in place.
Article 9 – Auditing, Reporting and Performance Indicators
9.1. Routine Reports: Monthly session count, Kt/V average, hypotension-cramp-infection rates, mortality/morbidity, HBsAg/Anti-HCV/HIV sero-epidemiology, and water system reports continuously submitted to the Institution.
9.2. Threshold Values: If infection rates or Kt/V values below the threshold, a corrective/preventive action (CPA) plan … days .
9.3. On-Site Inspections: Unannounced inspections may be conducted; a period of improvement may be given in case of non-conformity, or suspension/termination may be applied.
Article 10 – Guarantees, Insurance and Financial Security
10.1. Definitive Guarantee Letter : Prior to the contract , a definitive and unconditional guarantee letter in the amount of ………… TL will be provided from a bank designated by the Institution. It cannot be seized or subject to precautionary measures. 10.2. Financial Liability Insurance : The Center and physicians will maintain mandatory professional liability insurance; copies of the policies will be attached. 10.3. Recourse : Any payments/public losses made by the Institution in favor of the patient will be recouped from the Center in proportion to the fault.
Article 11 – Cases of Termination and Contract Prohibition
11.1. Serious Irregularity ( immediate termination without warning and a contract ban of … years ):
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Examples of fraudulent practices include forgery/falsification of invoices/documents, reuse of previously used materials, use of expired materials, billing for incomplete services as complete, billing unauthorized parties, price inflation, etc.
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Obstruction of audit, failure to provide requested documents.
The letter of guarantee is recorded as income (cannot be offset against the debt).
11.2. Breach of Obligation (gradual): -
initial detection, a written warning and %… will be imposed.
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Immediate termination in case of recurrence + forfeiture of security deposit. 11.3. Termination by Mutual Notification : The parties may terminate the agreement by registered mail with return receipt requested … months in advance. 11.4. Related Protocols : In case of non-compliance with joint protocols, the Institution may terminate the agreement ex officio.
Article 12 – Force Majeure
12.1. Natural disasters, war, strikes/lockouts, widespread epidemics, administrative bans, large-scale IT outages, etc., are considered force majeure . 12.2. The party shall notify in writing within … days ; if force majeure is proven, the obligations shall be suspended . In cases exceeding … days , the parties shall discuss the possibilities of justified termination
Article 13 – Resolution of Disputes
13.1. Competent Jurisdiction : Courts and enforcement offices of ……………… Province (where the institution unit is located). 13.2. (Optional) Insurance Arbitration/Mediation : ☑ Yes / ☐ No
If the arbitration option is selected, the application procedure and place of arbitration are shown in Appendix 3.
Article 14 – Contract Duration, Validity and Integrity
14.1. Period: …/…/20… – …/…/20… 14.2 . The annexes are an integral part of the contract. 14.3. Salaries/conditions for the new period will be redefined by the Institution; the Institution reserves the right to change the conditions before the end of the term . 14.4. The contract has been prepared and signed in duplicate .
Signature
the institution :
Name/Title: …………………………… Signature/Date: …………………
the Center :
Name/Title: …………………………… Signature/Date: …………………
List of Appendices
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Appendix 1: Scope – Package Contents (list of included/excluded drugs/consumables/transport/consultation, equipment inventory, staff schedule)
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Appendix 2: Erythropoietin Administration Procedure and Sample Follow-up Record
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Appendix 3: (Optional) Arbitration/Mediation Procedure
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Appendix 4: GDPR Information Text and Explicit Consent Templates
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Appendix 5: Audit Checklists (water system report, Kt/V, infection rates, HBYS logs)
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Appendix 6: Letter of Guarantee Specifications (bank, text, duration, definite-unlimited)
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Appendix 7: Billing Documentation (reports required to be attached to shipment, delivery schedule, objection procedure)
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Appendix 8: Personnel Certification and Shift Plans (responsible specialist/physician/nurse qualifications)
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Appendix 9: Hygiene and Infection Control Procedures (HCV areas, waste management, sterilization, water system quality parameters)
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Appendix 10: Emergency – Uninterrupted Service Plan (machine breakdown, electricity/water outage, relocation agreements)
Quick Filling Tips (Practical)
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Timeframes (notification, review, termination, force majeure): Most institutions prefer blocks of 3, 7, 10, or 30 days.
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Session duration: typically at least 4 hours; water level checks every 3 months .
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Letter of guarantee: 6-10% is practical.
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Report set: monthly quality report + water analysis + incident notification (hypotension, etc.) in a single file.
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