Is an electronic signature legally binding?

Yes. Electronic signatures are enforceable in interstate commerce under the ESIGN Act (15 U.S.C. §7001) and in most states under UETA; ensure intent, consent, attribution, and retention for validity.

When is a HIPAA BAA required?

A Business Associate Agreement is required whenever a vendor creates, receives, maintains, or transmits PHI on behalf of a covered entity; include BAA terms and security obligations in the contract.

Who can sign on behalf of an organization?

Signers must have corporate authority to bind the entity; verify signing authority through a corporate resolution or delegation and capture printed name and title in the signature block.

Do I need notarization or witnesses?

Most service contracts do not require notarization or witnesses, but state-specific requirements may apply for certain instruments; consult state rules if notarization or witnesses are anticipated.

How do I amend the agreement later?

Follow the amendment clause: obtain written consent from authorized signers, record the amendment with effective date, and attach it to the original agreement for retention.

How long must I keep the executed agreement?

Retain for the active term plus applicable federal or industry retention periods; HIPAA requires 6 years (45 CFR §164.530(j)) and IRS rules may require financial records for at least 3 years (IRC §6501(a)).

Electronic Signature
Templates
Healthcare
Healthcare CoreCare Agreement

Healthcare CoreCare Agreement

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

Healthcare CoreCare Agreement

Parties and Effective Date

This Healthcare CoreCare Agreement ("Agreement") is entered into between Patient Name: and Provider Name: .

Effective Date:

Patient Information

Patient Full Name

Date of Birth

Gender (select all that apply) Male
Female
Other/Non-binary

Address

Primary Phone

Email

Emergency Contact

Name Relationship Phone

Insurance Information

Primary Insurance Provider

Policy Number

Group Number

Subscriber Name

Medical History

Current Medications Allergies (including drug, latex, food) Prior Surgeries / Hospitalizations Chronic Conditions / Diagnoses

Scope of Services

Provider shall deliver CoreCare services as described below. Services may include primary care evaluation, chronic disease management, preventive care, health coaching, medication management, and care coordination. The specific services to be provided to Patient are:

Services Description

Fees, Billing and Insurance Assignment

Patient agrees to be responsible for charges not covered by insurance. Provider will submit claims to Patient's insurance carrier where applicable. Patient authorizes Provider to bill and assign benefits and payments from the listed insurer to Provider.

Estimated Fees or Co-pay (if applicable)

Consent to Treatment and Acknowledgments

Patient consents to evaluation, diagnostic testing, treatment and care coordination by Provider and Provider's authorized clinicians. Patient acknowledges that no guarantee can be made regarding results and that risks and benefits vary by procedure and treatment.

Specific Procedures or Treatments (if applicable)

By initialing the applicable boxes below, Patient confirms receipt of the listed disclosures and consents.

I consent to the delivery of CoreCare services as described above.
I consent to medication management and authorizing Provider to prescribe as medically necessary.
I consent to telehealth services when offered and accept associated risks and limitations.

Privacy, Use and Disclosure of Protected Health Information (PHI)

Patient acknowledges that Provider maintains a Notice of Privacy Practices describing uses and disclosures of PHI, patient rights, and Provider obligations. Patient authorizes Provider to use and disclose PHI for treatment, payment, and healthcare operations. Patient may revoke this authorization in writing, except to the extent Provider has already acted in reliance on it.

I acknowledge receipt of Provider's Notice of Privacy Practices and authorize use of my PHI as stated above.

Authorization to Release Medical Records

Patient authorizes Provider to release medical information to other healthcare entities, payers, or designated individuals as necessary for continuity of care, billing, or legal requirements. This release includes diagnostic test results, treatment summaries, and care plans.

Records Release To Authorization Expiration Date

Term, Termination and Continuity

This Agreement remains in effect until terminated by either party upon written notice. Termination does not relieve Patient of financial obligations for services rendered prior to termination. Provider will provide reasonable transition of care upon termination.

Representations, Warranties and Limitation of Liability

Patient represents that information provided is accurate and complete to the best of Patient's knowledge. Provider's liability for claims arising from care shall be limited to direct damages and shall exclude consequential, incidental, and punitive damages to the maximum extent permitted by law.

Dispute Resolution and Governing Law

Any dispute arising under this Agreement shall be resolved in accordance with applicable law. The parties agree to negotiate in good faith prior to pursuing formal dispute resolution. Governing law will be the law of the state in which Provider principally practices, unless otherwise required by applicable statute.

Electronic and Facsimile Signatures

The parties agree that electronic signatures and facsimile signatures are valid and have the same force and effect as original signatures for purposes of executing this Agreement.

Attestations

By signing below, Patient acknowledges that Patient has read, understands, and consents to the terms and conditions of this Agreement, has had the opportunity to ask questions, and authorizes Provider to provide care in accordance with this Agreement.

Patient Printed Name:

Signature:

Date:

If signed by Guardian/Representative, Relationship:

Representative Printed Name (if applicable):

Overview of the Healthcare CoreCare Agreement

The Healthcare CoreCare Agreement is a written contract that defines the relationship between a healthcare provider (or system) and a core care organization or vendor that delivers coordinated clinical and administrative services. Typical elements include the scope of services, roles and responsibilities, data sharing and privacy protections, payment and reconciliation terms, performance standards, term and termination clauses, and liability allocations. Because the agreement often involves protected health information, it commonly references a HIPAA business associate agreement and specifies security, audit, and compliance obligations applicable to both parties. Electronic execution is generally allowed under U.S. e-signature law when ESIGN/UETA requirements are met.

Why a Clear CoreCare Agreement Matters

A concise Healthcare CoreCare Agreement reduces operational ambiguity, protects patient data, and assigns financial and clinical responsibilities. It helps manage regulatory risk, clarifies performance expectations, and documents consent for PHI exchange under HIPAA.

Who Signs and Uses This Agreement

Common parties involved and practical roles for each signer.

Hospitals and health systems — contracting with core care vendors to coordinate transitions of care and population health management.
Managed care organizations and payers — defining care management, quality metrics, and payment reconciliation procedures.
Behavioral health and community provider networks — establishing data sharing and referral obligations across partners.

The agreement may also be used by ambulatory practices, specialty clinics, and vendor partners who handle PHI or provide administrative services.

Principal Sections to Include in a Professional Agreement

A complete Healthcare CoreCare Agreement organizes legal and operational terms so parties can manage care delivery, privacy, and payments.

Parties & Definitions

Identify contracting entities, affiliate relationships, and define key terms such as 'CoreCare Services', 'Protected Health Information', and 'Business Associate'.

Scope of Services

Specify services, deliverables, service levels, reporting frequency, escalation protocols, and excluded activities to prevent scope creep.

Data Use & Privacy

Describe permitted PHI exchange, minimum necessary rules, security controls, breach notification, and reference the HIPAA Business Associate Agreement.

Compensation & Invoicing

Set payment structure, invoicing cadence, allowable expenses, reconciliation process, dispute resolution, and withholding conditions.

Termination & Transition

State contract term, renewal mechanics, termination for cause or convenience, and data return or transition assistance obligations.

Liability & Indemnity

Allocate liability caps, exclusions, indemnity obligations, cyber insurance requirements, and remedies for regulatory fines or data breaches.

Required Information and Key Data Elements

Patient Identity: Full legal name and DOB

Provider Identity: Legal organization name

Effective Date: MM/DD/YYYY format

Scope Code: Service categories listed

Payment Terms: Frequency and amount

HIPAA BAA: BAA required indicator

Step-by-Step: Completing the Agreement

Follow these steps to prepare, review, and execute a Healthcare CoreCare Agreement accurately and consistently.

01

Gather documents: Collect provider IDs, business addresses, and BAA language.
02

Define services: Write precise service descriptions and measurable deliverables.
03

Set privacy terms: Attach or reference a HIPAA BAA and security controls.
04

Execute and retain: Sign electronically or on paper; archive per retention rules.

How to Customize the Agreement Online

Configure an online workflow to collect required fields, enforce authentication, and capture an audit trail for compliance.

Field	Configuration
Authentication Method	SMS code or email link
Field Prefill	Populate with patient/provider data
Conditional Sections	Show clinical clauses by selection
Audit Trail	Enable timestamps and IP logging

Where to Send or File the Executed Agreement

Choose destinations that align with compliance and operational needs, and ensure retention in a secure repository.

Internal Compliance Team: Store final copy for regulatory review
Vendor Contract Repository: Place signed agreement in vendor file
Care Coordination Platform: Link contract to operational system
Legal Counsel: Provide copy for risk and indemnity review

Digital Signing and Integration Considerations

Select a signing platform that supports required authentication, audit trails, and secure file formats for PHI.

Document Formats: PDF, DOCX, and secured exports
Integrations: Salesforce, Microsoft 365, NetSuite, Google Workspace
Security Standards: TLS in transit; AES-256 at rest

Ensure the chosen platform can execute a Business Associate Agreement when handling PHI, produce a detailed audit trail, and export signed records for long-term storage.

Typical Deadlines and Processing Expectations

Key dates and timing expectations help parties manage handoffs, billing, and compliance obligations under the agreement.

Execution Window:

Signatures should be completed before services begin

Effective Date:

Defines when performance and billing commence

Termination Notice:

Commonly 30–90 days written notice

Invoice Submission:

Net 30 or other agreed payment cycle

Breach Notification:

Immediate notification obligations upon PHI breach

Common Preparation Mistakes to Avoid

Vague scope language that leaves work and payment terms open to dispute between provider and vendor.
Failing to attach or reference a HIPAA Business Associate Agreement when PHI exchange is anticipated.
Using inconsistent party names or tax IDs, which causes payment delays and contract ambiguity.
Not defining data return or destruction procedures at contract end, complicating offboarding and compliance.

Potential Penalties and Contract Risks

HIPAA Fines: Civil penalties and corrective action

Breach Liability: Third-party claims and remediation costs

Contract Damages: Monetary remedies for performance failures

Regulatory Action: State licensing or enforcement risk

Payment Disputes: Withholding, interest, or litigation

Reputational Harm: Patient trust erosion and market impact

eSignature Vendor Pricing and Feature Snapshot

Compare common eSignature vendors on starting price and core features relevant to Healthcare CoreCare Agreement execution and PHI handling.

	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	Yes, 7-day trial	Yes	Yes	Yes	Yes
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Real-World Examples and Practical Outcomes

How organizations have used a signed CoreCare Agreement to improve coordination, compliance, and operational speed.

Fertility Centers of Illinois

A regional provider standardized contracting to centralize vendor security requirements and PHI handling

Reduced negotiation cycles by standardizing terms
"The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."

Optica Ventures LLC

A small network adopted an electronic workflow to collect signatures remotely

Improved turnaround on agreements and onboarding
The interface is simple for staff and customers, enabling faster execution without in-person meetings.

Practical Tips for Accurate, Efficient Agreements

Adopt consistent templates and workflows to reduce errors and speed execution while maintaining compliance.

Use a master template

Standardize core terms and BAAs in a master template to minimize redlines; track deviations and obtain legal approval for material changes.

Enforce required fields

Require tax IDs, effective date, and PHI scope before allowing signing to prevent incomplete agreements and payment delays.

Capture strong authentication

Apply two-factor or SMS authentication for remote signers when PHI is involved to increase attribution and reduce repudiation risk.

Archive signed records securely

Store executed agreements with access controls, encryption, and audit logs to satisfy HIPAA and auditing requirements.

Frequently Asked Questions about the Healthcare CoreCare Agreement

Answers to common questions about enforceability, PHI handling, electronic signatures, and amendments for Healthcare CoreCare Agreements.

Need help? Contact support

Is an electronic signature legally binding?
Yes. Electronic signatures are enforceable in interstate commerce under the ESIGN Act (15 U.S.C. §7001) and in most states under UETA; ensure intent, consent, attribution, and retention for validity.
When is a HIPAA BAA required?
A Business Associate Agreement is required whenever a vendor creates, receives, maintains, or transmits PHI on behalf of a covered entity; include BAA terms and security obligations in the contract.
Who can sign on behalf of an organization?
Signers must have corporate authority to bind the entity; verify signing authority through a corporate resolution or delegation and capture printed name and title in the signature block.
Do I need notarization or witnesses?
Most service contracts do not require notarization or witnesses, but state-specific requirements may apply for certain instruments; consult state rules if notarization or witnesses are anticipated.
How do I amend the agreement later?
Follow the amendment clause: obtain written consent from authorized signers, record the amendment with effective date, and attach it to the original agreement for retention.
How long must I keep the executed agreement?
Retain for the active term plus applicable federal or industry retention periods; HIPAA requires 6 years (45 CFR §164.530(j)) and IRS rules may require financial records for at least 3 years (IRC §6501(a)).

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now