Be sure to read this information completely, then sign your application on the next page to indicate your acknowledgment.
This Application is governed by and shall be construed in accordance with the laws of the State of Florida. NUCCA shall at all times be an independent contractor as to Applicant, and shall exercise objectivity in making all Accreditation determinations. In no event will NUCCA's aggregate liability arising out of or related to this Application exceed the Application Fee paid by Applicant.
All written or verbal information provided to National Urgent Care Center Accreditation (“NUCCA”) by Applicant regarding this Application, the survey and/or Accreditation process must be accurate, complete, and true. Applicant is subject to the current Accreditation policies and procedures of NUCCA. As an Accredited Center, the Applicant will receive notice regarding changes in NUCCA policies and procedures.
The Applicant agrees to hold NUCCA and its members, officers, directors, governors, examiners, and agents, free and harmless from any damage, expense, complaint, or cause of action whatsoever by reason of any action they, or any of them, may reasonably take in connection with this Application, the investigation of same, the failure of NUCCA to admit the Applicant to the Accreditation process. NUCCA makes no warranties, representations, or guarantees as to Applicant’s ability to obtain Accreditation.
NUCCA will maintain as confidential all information provided and will not disclose such information to any third party except on prior written authorization from the Applicant. If NUCCA and/ or its affiliates or representatives becomes legally compelled by law, process or order of any court or governmental agency or otherwise to disclose Confidential Information, or legal counsel therefore opines in writing that NUCCA or its affiliates or representatives is required to disclose any Confidential Information, NUCCA shall be relieved of its confidentiality obligations under this Section solely as and to the extent that it becomes legally compelled to disclose Confidential Information. As used herein “Confidential Information” shall include (i) all analyses, compilations, studies or other documents prepared by NUCCA or its representatives containing or based in whole or in part on any confidential information furnished by the Applicant, and (ii) all work product of any kind produced by NUCCA or its affiliates in the course of or in connection with the Accreditation.
Applicant agrees that the terms and conditions stated in this Application shall govern the relationship between Applicant and NUCCA, including this Accreditation, any additional locations seeking future accreditation, and renewal of Accreditation.
On behalf of the Applicant, the undersigned certifies that all information submitted is complete and accurate as of the date below. Applicant will notify NUCCA if there are any changes to this information. Applicant understands that the Accreditation application fees are due prior to NUCCA’s on-site survey, and that all fees should be paid to NUCCA. Applicant understands that in addition to the application fee, Applicant is responsible for all travel expenses for the surveyor (for example: airfare, hotel, car rental, meals, parking, tolls, etc.) which will be invoiced to the clinic after the completion of the on-site review(s).
I have read and understand the NUCCA refund policy:
Urgent Care Centers have 14 days from the date the application and application fee is received by National Urgent Care Center Accreditation (confirmation of receipt of payment is sent via email by the Accreditation Coordinator) to request a refund of their application fee (less $500 processing fee to be retained by National Urgent Care Center Accreditation) if they elect not to seek accreditation. Notification of non-pursuit of accreditation and request for refund must be submitted in writing (via postal mail or email). After 14 days all fees are non-refundable. If a clinic submits an application and application fee but never schedules an on-site, all fees will be retained by NUCCA.
Urgent Care Centers have up to six months from receipt of the application for accreditation by National Urgent Care Center Accreditation (confirmation of receipt of the application is sent via email the, Accreditation Coordinator) to complete the accreditation review. During that six-month period, a clinic is designated as “Accreditation Eligible”. If the accreditation review is not completed within six months of submission of the application for accreditation, the clinic will no longer be "Accreditation Eligible" and the application for accreditation will be purged from NUCCA records. All accreditation fees paid will be retained by NUCCA. If a clinic chooses to pursue accreditation after the six-month period, the clinic will need to submit a new application and application fee and the review will need to be scheduled within six weeks of receipt of the new application and fees.
I have read and understand the NUCCA rescheduling policy:
If an Urgent Care Center has an on-site review scheduled and needs to postpone the date of the review, the Urgent Care Center must contact the Accreditation Coordinator no less than 14 days prior to the date of the scheduled review to make a change to the review date. There will be a $100 rescheduling fee assessed to the Urgent Care Center (payable to NUCCA at the time the review date change is requested by the Urgent Care Center). Any travel change fees incurred by the surveyor will be included in the travel expenses which are invoiced to the clinic after completion of the on-site review.
Two reschedules of the review appointment are permitted. There is a $100 deferment fee for the each reschedule (payable to NUCCA at the time the review date change is requested by the Urgent Care Center). No additional reschedules will be permitted after the second reschedule.
