Fillable Field Bridge Site License Service Agreement printable pdf download

FIELD BRIDGE

Site License Request and Agreement with

State of NH, Bureau of EMS and ImageTrend, Inc.

Date: ____________

Service Requesting Field Bridge Site License:

Service Name:_________________________________________ NH License #:_________

Head of Service Name:_________________________________ Title:_________________

Service Address: ____________________________________________________________

Service City: _________________________ Service State: _____ Service Zip:___________

Number of computers Service expects to use with Field Bridge:__________

Service contact for Field Bridge administration, download and technical support:

Contact Name: ______________________________________ Title:___________________

Contact Email Address: _______________________________________________________

Contact or Service Phone: (____) _____________

FIELD BRIDGE SITE LICENSE SERVICE AGREEMENT

The New Hampshire Bureau of Emergency Medical Services (here-in-after “BEMS”) and ImageTrend, Inc. agrees to issue one

(1) site license for Field Bridge software, created by Image Trend, Inc, to the ____________________________ (here-in-after

“Service”). This site license will be issued to the Service for no cost to the Service for the Field Bridge Software Site License

only. Any Field Bridge licenses previously purchased by the Service from ImageTrend, Inc. are non-reimbursable through this

program. Each Field Bridge site license may be installed on as many computers as needed for that Service only. The Service

will be able to continue to use the Field Bridge Site License provided they meet the following requirements:

The BEMS or Service will maintain the annual software maintenance fees with ImageTrend, Inc. These fees cover

technical support and setup help provided directly through ImageTrend technical support to the Service, and include

any updates created by ImageTrend for the Field Bridge software.

The Service agrees to maintain their Field Bridge version of the software at the most current version of the software

available through ImageTrend, Inc.

Service agrees to submit all Emergency Medical Services Incident Reports to TEMSIS in accordance with NH State

Administrative Rules Saf-C 5902.08 and 5902.09.

The Service agrees to post all Emergency Medical Services Incident Reports captured through their Field Bridge

software to the TEMSIS “Service Bridge”. All Incident Reports will have a minimum validity score of 95%, or greater,

once posted in the Service Bridge and considered complete by the Service.

The BEMS and ImageTrend, Inc. reserve the right to repossess the Field Bridge Site License from the Service at any time,

should the Service fail to meet any of the agreement requirements. Service agrees to have the BEMS or Image Trend, Inc.

automatically set their Field Bridge software to update when version updates become available through Image Trend, Inc.

The Service acknowledges that it has sole responsibility for acquisition, maintenance, upgrade and cost of any computers,

hardware or internet access required for the use of Field Bridge or additional software or hardware required to import data from

a cardiac monitor into Field Bridge. The service further acknowledges that the Field Bridge is a mobile application of the Service

Bridge program and is not a full replacement for the Service Bridge, but is intended to be a tool to increase the convenience and

efficiency of entering information into the Service’s Service Bridge account in TEMSIS.

__________________ agrees to accept the site license and meet all requirements for maintaining and using the Field Bridge

Site License. This agreement is non-transferable by the Service.

Service Signature:

Head of Service Name:_________________________________ Title:_________________

Head of Service Signature:___________________________ _______Date: ____/____/_____

Field Bridge Site License Service Agreement