Disclaimer
The content provided is intended solely as a general example for informational purposes related to temporary medical staffing agreements. It does not constitute legal advice and should not be relied upon as a substitute for consulting a qualified attorney specializing in healthcare or contractual law. Laws and regulations may vary depending on the jurisdiction, and adjustments may be required to ensure compliance with local requirements. The use of this example is the sole responsibility of the user, and we assume no liability for any errors, omissions, or consequences arising from its use without professional review.
Please note: This is a sample Locum Tenens Agreement template for illustrative purposes only. Actual terms may vary based on specific arrangements and applicable laws.
Locum Tenens Agreement Sample
Parties Involved:
Hospital/Facility: XYZ Medical Center
Address: 123 Health Way, Springfield, IL 62704
Physician: Dr. John Doe
Address: 456 Maple Avenue, Springfield, IL 62704
Term of Assignment:
This agreement is effective from ______________________ to ______________________, covering the duration of the locum tenens assignment at the facility.
Scope of Services:
The physician shall provide medical services in the specialty of ______________________, including but not limited to clinic hours, on-call duties, and specific procedures as agreed upon.
Compensation:
The facility shall pay the physician a fee of $____ per day/week/month, payable according to the schedule outlined herein. Reimbursement for approved expenses shall be provided as per the attached schedule.
Physician Responsibilities:
The physician agrees to perform the assigned duties professionally, maintain applicable medical licenses, and adhere to facility policies and standards.
Governing Law:
This agreement shall be governed by the laws of the State of Illinois. Any disputes shall be settled within the courts of Sangamon County.
Additional Provisions:
- Both parties shall maintain confidentiality of patient information in accordance with HIPAA regulations.
- This agreement can only be modified in writing signed by both parties.
- Payment is contingent upon proper documentation and compliance with facility policies.
Springfield, ______________________
Dr. John Doe (Physician)
Authorized Representative (Facility)