DEED OF AGREEMENT between the COMMONWEALTH OF AUSTRALIA as represented by the Department of Health and ..………………………………………... …..………………………. …..…………………………………….. GIVEN NAME MIDDLE NAME FAMILY NAME for a Commonwealth Funded Internship place in 2016 under the Commonwealth Medical Internships initiative July 2015 THIS DEED OF AGREEMENT (AGREEMENT) is made BETWEEN the COMMONWEALTH OF AUSTRALIA as represented by the Department of Health (“the Commonwealth”) ABN: 83 605 426 759 AND ..………………………………………... …..…………………………… …..…………………………………….. GIVEN NAME MIDDLE NAME FAMILY NAME BACKGROUND A. The Commonwealth is funding The Commonwealth Medical Internships initiative (the Initiative), to provide up to 100 additional medical internships in Australia for 2016. B. The objective of the Initiative is to secure the services of medical practitioners to deliver services to rural and regional Australian communities and increase the number of Australian-trained medical practitioners working in Australia. The internships available have conditions attached to them designed to achieve that objective. C. You have applied for a Commonwealth Funded Internship place and You have been offered an internship under the Initiative. You have received information about the Initiative, the conditions attached to a Commonwealth Funded Internship, and the consequences if the conditions are not complied with. You acknowledge that You have been advised to seek independent legal advice on the Initiative, the conditions attached to the internship, and the consequences if the conditions are not complied with. D. One of the conditions of accepting a Commonwealth Funded Internship is that following successful completion of Your Commonwealth Funded Internship You gain general registration as a medical practitioner in Australia and You must complete Your Approved Return of Service Period in Australia. E. Under the Initiative any withdrawal from the Initiative will mean that You forfeit Your Commonwealth Funded Internship place. Without an internship place You will no longer participate in the Initiative. F. If You do not comply with Your obligations to complete Your Return of Service Period then You may be required to repay the Commonwealth Internship Cost plus interest as a debt due to the Commonwealth. G. Following assessment of Your application You have been selected to receive an offer of a Commonwealth Funded Internship. H. This Agreement is a contract for the purpose of section 19ABA of the Health Insurance Act 1973, and therefore a breach of certain conditions of this contract may incur a 2 year restriction on the use of Your Medicare provider number, during which Medicare benefits are not payable in respect of a Professional Service rendered by You or on Your behalf. 2 OPERATIVE PART OF THIS DEED OF AGREEMENT 1. 1.1 INTERPRETATION OF TERMS USED IN THIS AGREEMENT In this Agreement: Agreement means this Deed of Agreement including all schedules as amended from time to time; Approved Return of Service Placement means a total of forty eight (48) complete weeks of Work by You: a) in an area that falls within the Australian Standard Geographical Classification Remoteness Areas (ASGC-RA) 2-5; or b) in any other area as specified or agreed by the Commonwealth from time to time. Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) 2-5 means the most recent version of the ASGC-RA or its replacement during the period of this Agreement and during Your Return of Service Period. The ASGC-RA is a classification system developed by the Australian Bureau of Statistics and amended from time to time. Business Day means (a) for receiving a notice under clause 13, a day that is not a Saturday, Sunday, public holiday or bank holiday in the place where the notice is received; and (b) for all other purposes, any day that is not a Saturday or Sunday or a national public holiday; Commencement date means the date the last party signs this Deed; Commonwealth means the Commonwealth of Australia; Commonwealth Funded Internship means the intern place that You accept under this Agreement commencing in the 2016 calendar year; Commonwealth Internship Cost means the funding amount paid by the Commonwealth to the Internship Provider for the provision of a Commonwealth Funded Internship place; Credit means the number of weeks of Work You undertake during Your Commonwealth Funded Internship in an ASGC-RA 2-5 location and will be the number of weeks deducted from Your Return of Service Period; Department means the Department of Health or such other department or agency which is from time to time responsible for the administration of this Agreement; Department of Human Services means the Commonwealth department which as at the date of this Agreement has administrative responsibility for Medicare; Exceptional Circumstance means a circumstance beyond Your control, which was not reasonably foreseeable at the time You entered this Agreement and which prevents You from fulfilling an obligation or obligations under this Agreement, including but not limited to illness or temporary or permanent incapacity; 3 Interest means interest calculated at the 90 day bank accepted bill rate as published by the Reserve Bank of Australia, less 10%; Internship Provider means the organisation that has received payment of the Commonwealth Internship Cost for Your Commonwealth Funded Internship as detailed in Item B of the Schedule; Medical Practitioner means a person registered as a medical practitioner under a law of a State or Territory that provides for the registration of medical practitioners; Migration Act means the Migration Act 1958 (Cth) and the Migration Regulations 1994 (Cth); Minister means the Minister responsible for the administration of the Health Insurance Act 1973 (Cth), or a person authorised in writing by the Minister for the purposes of this Agreement; Professional Service has the same meaning as in the Health Insurance Act 1973 (Cth); Return of Service Period means a period or periods totalling forty eight (48) complete weeks of Work; Twenty (20) Hours Per Week means a minimum of 20 hours of Professional Services or 20 hours of salaried Work, or any combination of both for a minimum of 20 hours, that You provide each week; University means a university in Australia through which You completed Your Medical Course; and Work means a Medical Practitioner providing clinical medical services during the Return of Service Period. 1.2 In this Agreement, unless the contrary intention appears: (a) words importing a gender include any other gender; (b) words in the singular include the plural and words in the plural include the singular; (c) clause headings are inserted for convenient reference only and have no effect in limiting or extending the language of provisions to which they refer; (d) all references to dollars are to Australian dollars; (e) reference to any statute or other legislation (whether primary or subordinate) is to a statute or other legislation of the Commonwealth of Australia as amended or replaced from time to time; (f) where any word or phrase is given a defined meaning, any other part of speech or other grammatical form in respect of that word or phrase has a corresponding meaning; and (g) the Schedule and any attachments form part of this Agreement and where any conflict arises between the terms and conditions contained in the clauses of this Agreement and any part of the Schedule (and attachments if any), the 4 terms and conditions of the clauses in this Agreement prevail to the extent of the inconsistency. 2. 2.1 3. 3.1 OBLIGATIONS OF THE COMMONWEALTH TO YOU Subject to appropriation by the Parliament, the Commonwealth shall pay the Internship Provider an amount for the intern year to fund Your Commonwealth Funded Internship Place. That amount is the Commonwealth Internship Cost. YOUR OBLIGATIONS TO THE COMMONWEALTH You agree: (a) to successfully complete the Commonwealth Funded Internship within 12 months, and obtain general registration as a Medical Practitioner within 18 months, after commencement of Your Commonwealth Funded Internship; and (b) to complete Work in an Approved Return of Service Placement within five (5) years of commencing Your Commonwealth Funded Internship subject to clause 3.2; and (c) to Work in an Approved Return of Service Placement for the Return of Service Period on the following basis: (i) You must Work for a minimum period of four (4) continuous weeks; and (ii) You must Work for a minimum of Twenty (20) Hours Per Week during the Return of Service Period; and (iii) (d) any hours of Work in excess of Twenty (20) Hours cannot be counted in any other week; and unless You obtain Australian citizenship or permanent residency, to maintain and comply with all Your visa requirements under the Migration Act for the period during and until completion of Your Commonwealth Funded Internship and for the period during and until completion of Your Approved Return of Service Placement. For the avoidance of doubt, obtaining Australian citizenship or permanent residency between execution of this Agreement and completion of Your Return of Service Period will not alter Your obligations under this Agreement. 3.2 If You commence an Approved Return Of Service Placement that subsequently ceases to be an Approved Return of Service Placement You are entitled to continue to Work in that placement for the Return of Service Period in fulfilment of Your obligations under this Agreement. 3.3 If You have completed all of Your Commonwealth Funded Internship as an employee of a hospital located in an Australian Standard Geographical Classification Remoteness Areas (ASGC-RA) 2-5 and provide satisfactory written evidence of this, Your Commonwealth Funded Internship will satisfy all requirements of Your Return of Service Period and You will have no further obligations under this Agreement; 3.4 If You have completed any part of Your Commonwealth Funded Internship in an area that is within the Australian Standard Geographical Classification - Remoteness Areas 5 (ASGC-RA) 2-5, You may be eligible to receive a Credit towards Your Return of Service Period. 3.5 If You can provide written evidence satisfactory to the Department to verify Your claim for a Credit under clause 3.4 You may receive a Credit towards your Return of Service Period equivalent to the duration of Work spent in an ASGC-RA 2-5. This Credit will reduce Your Return of Service Period. 3.6 For the avoidance of doubt, You may render a Professional Service during the period following completion of Your Commonwealth Funded Internship and commencement of Your Approved Return of Service Placement. 4. 4.1 DEFERRAL You may defer Your Approved Return of Service Placement obligations as required by clauses 3.1(b) and (c): (a) for up to 12 months in respect of each child (or children in the case of multiple births) born to or adopted by You after the date of this Agreement, in which event You must notify the Department in writing no later than 30 days after the commencement of the period of deferral that You are proposing to exercise or have exercised, and the period of the deferral, which must include the day on which the child (or children in the case of multiple births) was born or adopted, together with supporting documentation; (b) in any other case involving Exceptional Circumstances, where You have applied in writing to the Minister for approval for deferral, and the Minister has given approval; (c) Any approval which may be given under clause 4.1(b) is at the Minister’s discretion and may be subject to further conditions. 4.2 5. 5.1 You agree to provide such information as the Minister requires to substantiate any deferral under clause 4.1 (a), or application for deferral under clause 4.1(b). YOUR OBLIGATIONS TO NOTIFY DEPARTMENT You agree to notify the Department in writing, including providing information that the Minister may require to substantiate such events, of any of the following within 30 days after one or more of the following events occur: (a) any change of Your contact details, including Your postal address, email address and telephone numbers; (b) Your failure of any part of the Commonwealth Funded Internship that extends the period to complete the Commonwealth Funded Internship; (c) Your discontinuance, failure of, exclusion or suspension from the Commonwealth Funded Internship; (d) If You no longer hold a visa as required under the Migration Act during the period of Your Commonwealth Internship or during the period of Your Approved Return of Service Placement; (e) If You have become a citizen or permanent resident of Australia; 6 (f) Your completion of the Commonwealth Funded Internship; (g) Your registration as a Medical Practitioner; (h) You commence Your Approved Return of Service Placement. You must provide the Department with the date, location and Your employer’s details; (i) Changes to the location and employer details of an Approved Return Of Service Placement; (j) the date on which You complete Your Approved Return Of Service Placement; (k) annual renewal of Your registration as a Medical Practitioner; (l) any other changes in Your circumstances that may affect this Agreement. 5.2 You agree to notify the Department in writing if You wish to withdraw from Your Commonwealth Funded Internship. 5.3 You agree to notify the Department in writing if You wish to withdraw from Your Approved Return of Service Placement. 5.4 You agree to provide the Department with such information as the Department may request relating to Your accountability to the Commonwealth under this Agreement. 6. 6.1 BREACH OF THIS AGREEMENT If You: (a) discontinue or withdraw from the Commonwealth Funded Internship and consequently the Initiative, after commencing the Commonwealth Funded Internship; (b) are excluded, suspended or terminated from the Commonwealth Funded Internship at any time after commencing the Commonwealth Funded Internship; (c) do not gain general registration as a Medical Practitioner within 18 months after commencement of the Commonwealth Funded Internship; (d) do not complete an Approved Return of Service Placement in accordance with clause 3.1(b) and (c), excluding any period of deferral under clause 4.1; (e) fail to Work in an Approved Return of Service Placement for the Return of Service Period in accordance with clause 3.1(c); then You will have breached this Agreement, unless the Minister in his or her discretion otherwise determines, and clause 7 and 8 will apply. 6.2 Apart from recovery of the Commonwealth Internship Cost under clause 7, the Commonwealth will not seek damages in respect of any breach of this Agreement by You. 6.3 If You breach this Agreement under clause 6.1 the Commonwealth may, in its absolute discretion, immediately terminate this Agreement by written notice to You. 7 6.4 7. If the Commonwealth terminates this Agreement under clause 6.3, then clauses 7 and 8 and any other provision in this Agreement which enables the Commonwealth to recover money from You for breach under clause 6.1 will survive that termination. RECOVERY OF COMMONWEALTH INTERNSHIP COST 7.1 You will not have to repay any of the Commonwealth Internship Cost for Your Commonwealth Funded Internship if You fulfil Your obligations under clause 3.1. 7.2 If You do not comply with your obligations under this Agreement as set out in clause 3.1, then subject to the exercise of any Ministerial discretion in accordance with clause 7.4, the Commonwealth may claim from You as a debt the Commonwealth Internship Cost plus Interest as an amount calculated in accordance with clause 7.3. 7.3 The amount that is referred to in clause 7.2 (before Interest is applied) is the Commonwealth Internship Cost in the amount up to a maximum amount of $140,000 which is a genuine pre-estimate of the loss suffered by the Commonwealth as a result of Your breach. 7.4 The Minister may reduce the amount You would otherwise owe the Commonwealth under clause 7.3 to such amount as the Minister, in his or her discretion, determines. The parties acknowledge and agree that any determination by the Minister may be subject to further conditions. 7.5 The amount to be repaid referred to in clause 7.2 and 7.3 becomes payable from the day that You breach this Agreement and Interest is calculated from that date. 8. 8.1 8.2 ELIGIBILITY FOR MEDICARE BENEFITS If You commit a breach of this Agreement to which clause 6.1 refers then, in accordance with section 19ABA of the Health Insurance Act 1973, Medicare benefits will not be payable in respect of Professional Services rendered by or on behalf of You for a period equal to twice the Return of Service Period, or a period of two (2) years from: (a) where you do not commence the Return of Service Period – the day after the date five (5) years from commencement of Your Commonwealth Funded Internship; or (b) subject to clause 3.1(c) where you have commenced but do not complete your Return of Service Period within five (5) years from commencement of Your Commonwealth Funded Internship – the day after You cease Work. In this case the period of two (2) years is reduced by double the number of complete weeks You have Worked. The Minister may reduce the period during which Medicare benefits will not be payable calculated under clause 8.1 as the Minister, in his or her discretion, determines. Any determination by the Minister pursuant to this clause may be subject to further conditions. 8 9. MINISTER’S DISCRETIONARY POWERS 9.1 Where the Minister exercises his or her discretionary powers under clauses 4.1(b), 6.1, 7.4 or 8.2 the Minister must consider any Exceptional Circumstance that may exist in Your particular case, such as Your temporary or permanent incapacity or illness. Assessment of Your temporary or permanent incapacity or illness may require a medical assessment by a Medical Practitioner selected by the Department. Exceptional Circumstances will be considered by the Minister on a case by case basis and the parties acknowledge and agree that the Minister’s decision may be subject to further conditions. 10. 10.1 AGREEMENT AND AUTHORITY TO RELEASE INFORMATION You agree that the Department may supply and exchange information (including email, phone and address details) about You to, and receive information about You from: (a) Department of Human Services, or such other department as may from time to time be responsible for the administration of Medicare; (b) Your University; (c) Your Internship Provider; (d) Your employer where You perform Your Commonwealth Funded Internship; (e) Your employer where You perform Your Approved Return of Service Placement; (f) Australian Health Practitioner Regulation Agency; (g) the Medical Board of Australia; (h) a Medical Practitioner selected by the Department under clause 9.1; (i) the Department of Immigration and Border Protection or such other department as may from time to time be responsible for the administration of Australian citizenship and permanent residency visas; or (j) next of kin or other family members or persons as notified by You from time to time, to enable the Department to monitor compliance by You with the provisions of this Agreement, You authorise the bodies referred to in paragraphs (a) to (j) to release and exchange such information as may be requested by the Department for this purpose. 11. 11.1 12. 12.1 EXPIRY OF THIS AGREEMENT Unless terminated earlier in accordance with clause 6.3, this Agreement will expire when both parties have fulfilled their obligations under the Agreement. GENERAL PROVISIONS The laws in force in the Australian Capital Territory apply to this Agreement and You and the Commonwealth submit to the exclusive jurisdiction of the courts of the Australian Capital Territory. 9 12.2 No variation of this Agreement is binding unless it is agreed in writing by both the Commonwealth and You. 12.3 If either the Commonwealth or You do not exercise (or delay in exercising) any right, that failure or delay does not operate as a waiver of any right contained in this Agreement or at law. 12.4 Any reading down or severance of a particular provision does not affect the other provisions of this Agreement. 12.5 You must not assign, in whole or part, Your rights or obligations under this Agreement. 13. 13.1 13.2 14. NOTICES Any notices or other communication required to be given under this Agreement must be in writing and may be: (a) delivered by hand to the physical address of the recipient and is deemed to be given upon delivery; (b) sent by pre-paid ordinary post within Australia to the postal address of the recipient and is deemed to be given upon the expiration of 3 Business Days after the date on which it was sent; (c) sent by facsimile message to the facsimile address of the recipient and is deemed to be given upon receipt by the sender of an acknowledgment that the communication has been properly transmitted to the recipient; or (d) sent by e-mail to the e-mail address of the recipient and is deemed to be given when the e-mail enters an information system accessible to the recipient. In this clause 13 reference to any kind of address means the address of the recipient stated in Item C of the Schedule or the address as updated by You under clause 5.1 of this Agreement. ACKNOWLEDGMENT AND AGREEMENT BY YOU 14.1 You acknowledge that You are not an Australian citizen and You agree to provide the Department with satisfactory evidence of this. 14.2 You acknowledge that this Agreement constitutes the entire agreement between You and the Commonwealth about its subject matter and supersedes all previous agreements, understandings and negotiations on that subject matter. 14.3 You agree that the Commonwealth enters into this Agreement with You in reliance upon the acknowledgments contained in clauses 14.1 and 14.2. 10 SCHEDULE Item A: Medical Course …………………………………………………………………………………………………………………………………...... Print course name and university Item B: Internship Provider ………………………………………………………………………………………………………………………………………. Print name of Internship Provider Item C: Addresses for purpose of receiving notices The address of the Department is: Commonwealth Medical Internships CMI Department of Health MDP 16 GPO Box 9848 CANBERRA ACT 2601 or such other address as the Department may notify to You. Contact Details: Email: Facsimile: CMI2016@health.gov.au (02) 6289 7333 Your postal address is: ….……………………………………………………… ……………………………………………………………………………………………….. ……………………………………………………………………………………………….. Your residential address is: (if different to postal address) ……………………………………………………………………………………………….. ……………………………………………………………………………………………….. ……………………………………………………………………………………………….. ……………………………………………………………………………………………….. Phone number:………………………………Mobile number:………………………………. Your e-mail address:………………………………………………………………………………… Facsimile:………………………………………………………………………………………………... or such other address as You may notify to the Commonwealth from time to time. 11 Executed as a Deed SIGNED SEALED AND DELIVERED for and on behalf of the COMMONWEALTH OF AUSTRALIA by the Director, Health Professional Training Section in the Department of Health ……………………………………………. (Printed Name of Director) ……………………………………. (Signature) Date: in the presence of: ……………………………………………. (Printed Name of Witness) ……………………………………. (Signature) Date: SIGNED SEALED AND DELIVERED by …..………………….. …..…………………… …..…………………….. Print GIVEN NAME MIDDLE NAME FAMILY NAME ……………………………………. (Signature) Date: in the presence of: ……………………………………………. (Printed Name of Witness) ……………………………………. (Signature) Date: 12