Organizational Affiliate Memorandum of Understanding Between Next Harm Reduction and [ORG] Next Harm Reduction “NHR” and [ORG] share a goal of reducing opioid overdose mortality in the state of [State] through online and mail-based opioid overdose mortality prevention training and materials at no cost via the website naloxoneforall.org “Website”. Both parties work under the philosophy of harm reduction and utilize community-based naloxone distribution to reach our goal. 1. CONFIDENTIAL INFORMATION (a) Both parties agree that meeting our shared goal necessitates the disclosure of Confidential Information obtained by NHR through Website to [ORG] who is designated as the Website state affiliate. (ai) Both parties acknowledge that names, addresses, and emails of clients who have enrolled to receive services through Website constitutes Confidential Information. (aii) Both parties acknowledge that any information included on the Website enrollment when paired the client’s corresponding name, address, or email is Confidential Information. (b) Confidential Information shall never be made public or disclosed to a third party under any circumstance. For that reason, Confidential Information will not be copied into a secondary dataset, added to an email listserv, or added to promotional mail or email solicitations of any type. [ORG] is prohibited from contacting the client for any reason unless first approved by NHR through email exchange (verbal agreements prohibited). (c) Each individual involved with affiliate organization who will be accessing Confidential Information will be made aware of the agreements contained in this MOU. (d) [ORG] is welcome to solicit client in any manner they deem advantageous during their initial mailing only. (ci) If a client pro-actively signs up for [ORG] services, solicitations, or promotional opportunities, Section (b) is rendered null. (e) [ORG] is welcome to utilize aggregate data to inform services, funder proposals, or for any other purpose. 2. CO-BRANDING (a) With the permission of [ORG], NHR will list [ORG]’s logo and link system users to their website or url of their choice. (b) NHR invites [ORG] to co-brand educational and promotional materials that will be sent out with each shipment, however this remains the decision of [ORG]. (bi) NHR edits all pamphlets using Canva, [ORG] is granted full edit permissions on co-branded pamphlets (bii) If [ORG] chooses not to co-brand information or include Next Naloxone branded information with each shipment, the information sent must include reference to the Opioid Overdose Reversal Form located at www.naloxoneforall.org/reverse 3. CHANGE IN ABILITY TO PROVIDE SERVICE (a) If [ORG] has difficulty or believes it will be having difficulty in the future fulfilling the role of [State] affiliate at anytime, [ORG] has the duty to communicate this with NHR as early as possible. This includes but is not limited to staff vacation or leave, budgetary issue, or naloxone shortage. (ai) NHR will attempt to recruit an additional state affiliate or prepare to provide mailings during this time, dependent on situation and projected length of that situation.
4. NEXT NALOXONE WEBSITE BUILD-OUT (a) Build-out of the website specific to [State] will be completed in partnership with [ORG] and dependent on [State] or [ORG] resources and ability to do so. NHR is committed to broadening the website scope in partnership with [ORG] but lacks the funds to do so to the extent we would like. 5. LEGAL (a) NHR does not take a position or provide guidance on the [ORG]’s ability to legally mail naloxone within their specific state. 6. TIMEFRAME (a) This MOU will begin on the date signed by both parties and will stay in effect until either organization withdraws partnership in writing or through email notification. ________________________________ Jamie Favaro Executive Director Next Harm Reduction
________________________________ Name Title [ORG]
________________________________ Email
________________________________ Email
________________________________ Phone
________________________________ Phone
________________________________ Date
________________________________ Date
If applicable: Additional individuals who will be accessing Confidential Information through an affiliate partnership between Next Harm Reduction and [ORG]. ________________________________ Name
________________________________ Name
________________________________ Title
________________________________ Title
________________________________ Email
________________________________ Email
________________________________ Phone
________________________________ Phone
________________________________ Date
________________________________ Date