Can this agreement be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the parties demonstrate intent, consent, attribution, and record retention capability.

Is a Business Associate Addendum required?

If the agreement allows access to or disclosure of protected health information, include a HIPAA Business Associate Addendum and ensure the vendor or partner can sign a BAA.

Who should sign on behalf of the clinical site?

An authorized executive or contracts officer with explicit signature authority should sign. Confirm delegated authority in internal policy or corporate bylaws to avoid later disputes.

Do I need notarization or witnesses?

Not typically required for standard affiliation agreements, but some state-specific instruments or attachments may require notarization; verify with local counsel and the host site's policies.

How long should we retain executed agreements?

Retain for the full term plus at least three years; healthcare-related records with PHI should be kept six years (45 CFR §164.530(j)); consult state rules for longer periods.

Can I require stronger signer authentication?

Yes. Use multi-factor authentication, ID verification, or RON where permitted. Stronger authentication improves attribution and is appropriate when higher assurance is needed.

Electronic Signature
Templates
Healthcare
Healthcare Clinical Affiliation Agreement

Healthcare Clinical Affiliation Agreement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HEALTHCARE CLINICAL AFFILIATION AGREEMENT

This Clinical Affiliation Agreement (the Agreement) is entered into as of (Effective Date) by and between Clinical Site Name: located at , and Educational Institution Name: located at .

RECITALS

WHEREAS, the Institution operates an educational health professions program known as: (Program), which requires supervised clinical experience for its students; and

WHEREAS, the Clinical Site operates healthcare facilities and is willing to accept students from the Institution for clinical placements under the terms and conditions set forth herein.

TERM

The term of this Agreement shall commence on the Effective Date and continue until unless earlier terminated in accordance with Section Termination below. The parties may extend this Agreement by mutual written amendment.

DEFINITIONS

"Student" means an enrolled individual in the Program participating in a clinical education activity under this Agreement. "Supervising Practitioner" means a Clinical Site-licensed practitioner assigned to provide on-site supervision of Students. "Confidential Information" includes patient health information and any proprietary information of the Clinical Site in accordance with applicable privacy laws.

RESPONSIBILITIES OF THE INSTITUTION

The Institution shall:

1. Provide Students who meet the Clinical Site's credentialing and documentation requirements, including but not limited to proof of health screenings, immunizations, current cardiopulmonary resuscitation certification, and any background checks required by the Clinical Site.

Student documentation maintained by Institution

2. Require that Students comply with all Clinical Site policies and applicable law including patient privacy and safety standards. Institution shall ensure that each Student is provided instruction regarding confidentiality and applicable privacy rules prior to placement.

3. Maintain professional liability insurance covering Students while performing clinical activities at the Clinical Site with limits not less than: Coverage Limits: $ per occurrence.

RESPONSIBILITIES OF THE CLINICAL SITE

The Clinical Site shall:

1. Provide orientation, appropriate clinical supervision, evaluation of Student performance, and access to necessary clinical areas consistent with teaching goals and patient safety.

Clinical Site contact for placements

STUDENT HEALTH, SAFETY AND BACKGROUND CHECKS

The Institution represents that each Student assigned to the Clinical Site shall, as a condition of placement, provide evidence of the following when required by the Clinical Site:

Required immunizations (per Clinical Site policy)

Current CPR/BLS certification

Tuberculosis screening or clearance

Criminal background check and clearance

The Institution shall maintain records of the foregoing and shall provide copies to the Clinical Site upon request. Students who fail to meet these requirements shall not be permitted on-site.

CONFIDENTIALITY, PRIVACY AND HIPAA COMPLIANCE

Each party shall comply with all applicable federal and state privacy laws and regulations governing the protection of patient health information. Institution agrees that Students will access Protected Health Information only as necessary for educational purposes and under direct supervision. Institution and its Students shall execute any reasonable confidentiality agreements required by the Clinical Site.

Clinical Site confidentiality requirements (if any)

INSURANCE AND LIABILITY

Each party shall maintain insurance adequate to cover its obligations under this Agreement. The Institution shall ensure that Students are covered by professional liability insurance while participating at the Clinical Site. Upon request, the Institution shall furnish certificates of insurance evidencing required coverage and naming the Clinical Site as an additional insured where required by the Clinical Site.

Institution insurance provider Policy number

INDEMNIFICATION

The Institution shall indemnify, defend and hold harmless the Clinical Site, its directors, officers, employees and agents from and against any and all claims, liabilities, losses, and expenses (including reasonable attorneys' fees) arising out of acts or omissions of the Institution or its Students, except to the extent caused by the Clinical Site's gross negligence or willful misconduct. The Clinical Site shall indemnify the Institution to the extent any claim arises from the Clinical Site's gross negligence or willful misconduct.

TERMINATION

Either party may terminate this Agreement for convenience upon days' prior written notice to the other party. Either party may terminate immediately for material breach, including failure to comply with patient privacy laws or safety policies.

INCIDENT REPORTING AND RECORDKEEPING

The Clinical Site shall notify the Institution within a reasonable time of any adverse event, patient injury, or incident involving a Student. The Institution shall cooperate with any investigation and shall maintain records of Student performance and placement activities in accordance with applicable law.

NOTICES

All notices under this Agreement shall be in writing and delivered to the addresses below by certified mail, personal delivery or other mutually agreed method.

Clinical Site address for notice Institution address for notice

DISPUTE RESOLUTION

The parties agree to attempt in good faith to resolve any dispute arising under this Agreement through negotiation between senior representatives. If resolution cannot be reached, the parties agree to submit to mediation prior to pursuing litigation. This Agreement shall be governed by the laws of the jurisdiction in which the Clinical Site is located, without regard to conflict of laws principles.

ENTIRE AGREEMENT; AMENDMENT

This Agreement constitutes the entire understanding between the parties with respect to clinical placements and supersedes all prior discussions and agreements. Any amendment to this Agreement must be in writing and signed by authorized representatives of both parties.

Exhibit A — Description of clinical placements (units, departments, expected student numbers)

AUTHORIZATIONS

The undersigned represent and warrant that they are authorized to execute this Agreement on behalf of their respective organizations and that their execution constitutes a binding obligation of such organizations.

Clinical Site — Printed Name:

By (Signature):

Title:

Date:

Institution — Printed Name:

By (Signature):

Title:

Date:

What a Healthcare Clinical Affiliation Agreement Is

A Healthcare Clinical Affiliation Agreement is a written contract that sets the terms under which an academic program, clinical training program, or healthcare facility permits students, residents, or allied health professionals to perform supervised clinical activities at the host site. The agreement defines scope of training, educational objectives, supervision levels, liability allocation, insurance requirements, patient privacy obligations, and administrative responsibilities. In the United States these agreements must be consistent with federal law (for example ESIGN and HIPAA) and applicable state rules governing clinical placements and professional practice.

Why this agreement matters for training programs and facilities

A clear, executed affiliation agreement protects patient privacy, clarifies insurer and liability responsibilities, and documents the training relationship between the academic institution and the clinical site.

Who typically completes and signs these agreements

Both educational institutions and clinical sites use affiliation agreements to formalize placements; multiple internal roles contribute to preparation and approval.

Academic program administrators and clinical coordinators responsible for student placements and accreditation compliance.
Healthcare facility legal counsel or contracts officers who review risk allocation, indemnity, and insurance terms.
Chief medical officer, director of nursing, or an authorized executive with signature authority for the host site.

The final signers are usually those with authority to bind their organizations and who can confirm insurance, credentialing, and HIPAA controls.

Step-by-step: completing a Healthcare Clinical Affiliation Agreement

Follow these steps in order to prepare, review, and execute an affiliation agreement with minimal rework.

01

Assemble parties: Identify academic and clinical leads and their authority to sign.
02

Populate core fields: Complete names, dates, scope of training, supervision, and insurance.
03

Legal and compliance review: Have contracts counsel and HIPAA privacy officer review the draft.
04

Execution and distribution: Obtain signatures, then distribute final copies to stakeholders and retain originals.

Core clauses to include in a professional affiliation agreement

A thorough agreement clarifies responsibilities, patient privacy protections, and the operational details necessary for safe supervised clinical training.

Scope of Training

Defines student activities, permitted procedures, supervision ratios, and learning objectives tied to the placement.

Credentialing and Access

Specifies how students and faculty obtain EMR access, ID badges, immunization verification, and background checks.

HIPAA and Privacy

Requires compliant handling of PHI, minimum safeguards, and a Business Associate Addendum if protected health information is exchanged.

Insurance and Indemnity

States required liability coverages, primary vs secondary coverage, and indemnity allocations between parties.

Termination and Suspension

Outlines rights to suspend placements for cause, notice periods, and steps for resolving breaches.

Reporting and Accreditation

Describes reporting responsibilities, record access for audits, and obligations to comply with accrediting body standards.

Essential operational and compliance details to record

HIPAA BAA: Include if PHI will be accessed

Insurance Limits: List minimum policy amounts

Supervision Level: Define preceptor-to-student ratio

Credentialing Steps: Specify ID, EMR access requirements

Term Dates: Start and end dates required

Record Access: Audit and inspection rights

Consequences of incomplete or incorrect agreements

HIPAA Violations: Civil/criminal exposure and corrective action

Insurance Gaps: Out-of-pocket liability for incidents

Accreditation Risk: Negative findings or sanctions

Placement Suspension: Training interruptions for students

Contract Disputes: Costly litigation or arbitration

Regulatory Penalties: State fines or licensing consequences

Common mistakes to avoid when preparing the agreement

Using nonstandard or ambiguous supervision language that creates operational confusion
Failing to include HIPAA-specific language and a BAA when PHI access is necessary
Mismatched legal names or missing tax identification information that delay procurement and contracting
Omitting explicit insurance limits, certificate requirements, or proof-of-coverage timing

How to configure an online workflow for execution

Set up an eSigning workflow that captures required approvals, identity checks, and the final executed record.

Field	Configuration
Signature Order	Sequential or parallel signer routing
Authentication	Email link, SMS code, or stronger ID verification
Document Lock	Prevent edits after signing
Audit Trail	Capture timestamps, IP, and actions

Technical and platform considerations for eExecution

Choose a platform that supports audit trails, HIPAA controls, and integrations with clinical systems where needed.

File formats: PDF and DOCX supported
Integrations: EMR and document management connectors
Security: TLS/AES encryption at rest

Where to send and how routing typically works

Typical routing moves from the requesting academic program to the clinical site legal team, then to authorized signers and back to both parties for record retention.

Upload: Sender uploads completed draft
Place fields: Add signature, date, and initial fields
Assign signers: Enter authorized signer emails and order
Distribute: Send executed copies to records holders

Key timing and deadlines to track

Track effective date, insurance evidence deadlines, student onboarding timelines, and renewal notice periods to avoid service interruptions.

Effective Date:

MM/DD/YYYY — when obligations begin

Insurance Proof Due:

Prior to student entry

Onboarding Complete:

Typically 2–4 weeks before placement

Renewal Notice:

60–90 days before term end

Record Retention Start:

At execution date

Key milestones from negotiation to active placement

A sequential view of major stages helps keep administrative and compliance tasks aligned during setup and execution.

01

Drafting

Parties agree core terms and draft a mutual template.

02

Review

Legal and privacy teams review and request revisions.

03

Insurance Verification

Certificates are provided and confirmed before access is granted.

04

Execution

Authorized signers sign, and executed copies are distributed.

Representative vendor pricing and capability snapshot

Compare baseline pricing and common capability differences. Ensure any selected vendor meets HIPAA and audit-trail requirements for healthcare agreements.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Yes	Yes	Yes	Yes
Bulk Send	Yes (Business Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about Healthcare Clinical Affiliation Agreements

Answers to common questions about validity, signatures, HIPAA, and recordkeeping for affiliation agreements.

Need help? Contact support

Can this agreement be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the parties demonstrate intent, consent, attribution, and record retention capability.
Is a Business Associate Addendum required?
If the agreement allows access to or disclosure of protected health information, include a HIPAA Business Associate Addendum and ensure the vendor or partner can sign a BAA.
Who should sign on behalf of the clinical site?
An authorized executive or contracts officer with explicit signature authority should sign. Confirm delegated authority in internal policy or corporate bylaws to avoid later disputes.
Do I need notarization or witnesses?
Not typically required for standard affiliation agreements, but some state-specific instruments or attachments may require notarization; verify with local counsel and the host site's policies.
How long should we retain executed agreements?
Retain for the full term plus at least three years; healthcare-related records with PHI should be kept six years (45 CFR §164.530(j)); consult state rules for longer periods.
Can I require stronger signer authentication?
Yes. Use multi-factor authentication, ID verification, or RON where permitted. Stronger authentication improves attribution and is appropriate when higher assurance is needed.

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