Is an electronic signature valid?

Yes. Electronic signatures are generally legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.

Do I need a BAA for PHI?

Yes. If the vendor or counterparty will create, receive, maintain, or transmit protected health information, a Business Associate Agreement must be in place to meet HIPAA obligations.

When is notarization required?

Most standard employment or service agreements do not require notarization, but state or transaction-specific documents (powers of attorney, some affidavits) may. Verify local notary rules.

What if names differ on documents?

Mismatched provider names across license, W-9, and contract can delay credentialing and payment; correct names to match government-issued credentials.

Can I use remote online notarization?

RON availability varies by state. Where allowed, follow identity-proofing and audio-video record retention rules required by state notary law.

How long keep signed agreements?

Follow retention rules: retain active agreements through the contract term plus at least 3 years, and HIPAA-related documents for 6 years (45 CFR §164.530(j)).

Electronic Signature
Templates
Healthcare
Healthcare Doctor Agreement

Healthcare Doctor Agreement

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

HEALTHCARE DOCTOR AGREEMENT

This Healthcare Doctor Agreement ("Agreement") is made and entered into as of Effective Date: by and between Practice Name: located at Practice Address: ("Practice") and Doctor Name: ("Doctor").

RECITALS

WHEREAS, Practice operates a healthcare facility and provides medical services to patients; and WHEREAS, Doctor is duly licensed to practice medicine and possesses the qualifications to provide medical services; and WHEREAS, Practice desires to engage Doctor and Doctor desires to provide medical services on the terms set forth in this Agreement.

1. ENGAGEMENT; STATUS

Practice hereby engages Doctor to provide professional medical services and Doctor accepts such engagement. The parties agree that Doctor shall perform services as an Independent Contractor Employee . The selected status controls tax withholding, benefits eligibility, and other employment rights, subject to applicable law.

2. TERM

The initial term of this Agreement shall commence on Start Date: and shall continue for a period of months, unless earlier terminated in accordance with Section 12 below. The term shall automatically renew for successive month(s) periods unless either party provides written notice of non-renewal at least days prior to the end of the then-current term.

3. DUTIES AND STANDARD OF CARE

Doctor shall provide medical services consistent with generally accepted standards of medical practice, applicable federal and state laws, and Practice policies. Doctor shall maintain current licensure, credentials and privileges required to perform the services and shall at all times exercise independent clinical judgment. Doctor agrees to cooperate in peer review, quality assurance, and utilization review activities.

4. SCHEDULE AND COVERAGE

Regular Schedule (days / hours) On-Call / Coverage Obligations

5. COMPENSATION; BILLING

Practice shall compensate Doctor as set forth below. Doctor is responsible for timely submission of documentation required to support payment. Doctor acknowledges that compensation is contingent upon compliance with Practice policies, credentialing and payer contracts.

Compensation Method (select all that apply)

Base Salary Productivity (percentage of collections) Guaranteed Minimum / Stipend Other

Compensation Details Billing Entity

6. MALPRACTICE INSURANCE

Doctor shall, at Doctor's sole cost, maintain professional liability insurance with minimum limits of and shall name Practice as an additional insured or provide tail coverage as required upon termination. Doctor shall provide certificates of insurance evidencing the required coverage to Practice prior to the commencement of services and upon renewal.

Insurance Carrier Policy Number Policy Expiration Date

7. CREDENTIALING AND LICENSURE

State Medical License Number State of Licensure License Expiration Date DEA Number NPI Number

8. COMPLIANCE WITH LAWS AND PRACTICE POLICIES

Doctor shall comply with all applicable federal, state and local laws, rules and regulations, including but not limited to anti-kickback, Stark/self-referral laws, and all applicable payer rules. Doctor shall comply with Practice policies, bylaws, rules and regulations when treating Practice patients.

9. CONFIDENTIALITY; HIPAA

Doctor shall maintain the confidentiality of patient information and protect Protected Health Information (PHI) in accordance with applicable privacy laws. Doctor shall execute any Business Associate Agreement or other document required by Practice to effectuate HIPAA compliance.

Doctor acknowledges receipt of and agrees to comply with Practice's policies regarding patient privacy and HIPAA.

10. MEDICAL RECORDS; RECORD OWNERSHIP

All medical records and patient charts created in the course of treatment of Practice patients shall be maintained in accordance with applicable law and Practice policy. Ownership of records shall rest with Practice to the extent permitted by law; Doctor shall not alter or remove original records and shall provide copies as required.

11. INDEMNIFICATION

Each party shall indemnify, defend and hold harmless the other party from and against liabilities, losses, claims, costs and expenses arising from the indemnifying party's negligence, willful misconduct, breach of this Agreement or violation of law, except to the extent caused by the indemnitee's own gross negligence or willful misconduct.

12. TERMINATION

This Agreement may be terminated by either party for convenience upon days' prior written notice. Practice may immediately suspend or terminate this Agreement for reasons including but not limited to loss of license, material breach, conviction of a felony, or failure to maintain required insurance.

13. DISPUTE RESOLUTION; GOVERNING LAW

The parties agree to negotiate in good faith to resolve any dispute arising under this Agreement. Unless the parties otherwise agree in writing, disputes not resolved by negotiation shall be subject to binding arbitration under the rules of a recognized arbitration forum, with the arbitration to be governed by the laws of State: .

14. NOTICES

Practice Notice Address Doctor Notice Address

15. MISCELLANEOUS

This Agreement, including any exhibits attached, constitutes the entire agreement between the parties and supersedes all prior agreements. No amendment shall be effective unless in writing and signed by both parties. Neither party may assign this Agreement without the prior written consent of the other, except that Practice may assign to an affiliate or successor entity upon notice to Doctor.

Additional Terms / Exhibits (Exhibit A: Scope of Services, etc.)

16. REPRESENTATIONS AND WARRANTIES

Doctor represents and warrants that Doctor holds all licenses, certificates and permits required to perform the services, that such credentials are in good standing, and that there are no pending actions that would materially impair Doctor's ability to perform hereunder. Doctor shall promptly notify Practice in writing of any change in status, sanctions, or pending investigations.

CONTACTS

Practice Primary Contact Name Practice Contact Phone Doctor Mobile Phone Doctor Email

Practice Printed Name:

By:

Date:

Doctor Printed Name:

By:

Date:

What a Healthcare Doctor Agreement Covers

A Healthcare Doctor Agreement is a written contract that sets out the working relationship, responsibilities, compensation, confidentiality, and compliance obligations between a medical provider (physician, surgeon, or independent contractor) and a healthcare entity (clinic, hospital, or practice). It addresses scope of services, credentialing, medical records access, HIPAA and privacy obligations, termination terms, indemnification, and dispute resolution to reduce ambiguity in clinical and administrative duties.

Why a Clear Agreement Matters for Care and Compliance

A precise Healthcare Doctor Agreement reduces legal and operational risk by documenting clinical scope, billing responsibilities, credentialing timelines, confidentiality, and compliance with HIPAA and applicable state law.

Who typically prepares and signs this agreement

Common participants involved in drafting and executing a Healthcare Doctor Agreement.

Practice administrators and medical group managers who need defined clinical and billing arrangements.
Individual physicians or locum tenens providers seeking clear liability, compensation, and termination terms.
Hospital legal or credentialing departments that must ensure regulatory compliance and privileging.

Step-by-step: completing a Healthcare Doctor Agreement

Follow these sequential steps to prepare, review, and finalize the agreement while keeping compliance, credentialing, and billing on track.

01

Gather documents: Collect licenses, DEA, CV, malpractice history.
02

Draft terms: Define scope, compensation, and HIPAA obligations.
03

Legal review: Have counsel check indemnity and regulatory clauses.
04

Execute: Sign, date, and distribute final copies to stakeholders.

Core contract elements to include

A professional Healthcare Doctor Agreement contains several standard sections that protect patients, clinicians, and facilities while supporting operational clarity.

Parties

Identify the contracting entities by full legal name, business form, and principal place of business to establish who is bound by the agreement.

Scope of Services

Detail permitted services, clinical settings, call/on-call obligations, supervision or delegation rules, and any limits on procedures or patient populations.

Compensation

Specify salary, productivity measures, collections splits, benefits, reimbursement of expenses, and the timetable for payments and reconciliations.

Compliance and Privacy

Include HIPAA obligations, requirement for BAA where applicable, reporting duties, and obligations to follow federal and state healthcare laws.

Liability and Insurance

State malpractice insurance minimums, claims-made vs occurrence policies, indemnification language, and notice procedures for claims.

Termination and Transition

Describe termination for cause/without cause, notice periods, patient transfer obligations, and post-termination confidentiality or noncompete provisions if enforceable.

Data, privacy, and security items to specify

HIPAA BAA: Include a Business Associate Agreement where PHI is handled.

Access Controls: Limit EHR access by role and document audit requirements.

Breach Notice: Define notification timing and remediation responsibilities.

Data Retention: Specify record retention consistent with HIPAA and state law.

Encryption: Require encryption of PHI in transit and at rest.

Remote Access: Set multi-factor authentication rules for telework and VPN.

Risks and potential penalties for noncompliance

HIPAA Violations: Civil monetary penalties and corrective action plans under HHS OCR, up to high-dollar fines depending on culpability.

Breach Notification Failures: Fines and reputational damage for failing to notify affected individuals or HHS within required timelines.

Credentialing Errors: Delayed privileging and reimbursement denials when license or DEA information is incorrect.

Malpractice Gaps: Coverage lapses can expose the provider and facility to uninsured claim liability.

Stark/AKS Issues: Improper financial arrangements may trigger False Claims Act exposure and civil penalties.

Contract Ambiguity: Unclear termination or payment terms increase litigation risk and operational disruption.

Common preparation pitfalls to avoid

Using inconsistent provider names across credentialing and tax documents, which delays enrollment.
Vague scope or duties that lead to disputes over on-call and coverage obligations.
Omitting HIPAA or BAA terms when PHI exchange is routine between parties.
Failing to align compensation language with payer contracts and billing responsibility rules.

Typical administration and routing workflow

A standard process helps complete credentialing, approvals, and execution with minimal friction.

Prepare package: Collect CV, licenses, malpractice history.
Credentialing review: Submit to hospital or payer credentialing committee.
Legal review: Counsel reviews indemnity and regulatory clauses.
Execution: Signatures collected and final copies distributed.

Digital workflow settings to configure

Configure the e-sign and routing workflow to reflect review, signer order, and authentication needs.

Field	Configuration
Signer Order	Set sequential signing: practice admin → provider → legal
Authentication	Use email + SMS code for provider identity verification
Conditional Fields	Show compensation fields only for employed providers
Audit Trail	Enable capture of IP, timestamp, and action log

Technical distribution and signing options

Choose platforms and delivery methods that meet your authentication and recordkeeping needs.

PDF and DOCX: Support for PDF and Word document formats for templates and final records.
Integrations: Connectors for EHR, HRIS, and document storage systems reduce manual work.
Authentication: Offer email, SMS code, KBA, or advanced signer authentication per risk level.

Timing and typical deadlines to track

Track dates for credentialing, start of coverage, and notice periods to avoid operational lapses and payment interruptions.

Credentialing:

Allow 60–120 days for payer and facility credentialing.

Insurance Proof:

Require current malpractice certificate before start date.

Effective Date:

Set clear MM/DD/YYYY effective start and prorated pay periods.

Termination Notice:

Commonly 30–90 days depending on agreement clause.

Contract Renewal:

Set internal review 60 days before expiration to renegotiate.

eSignature pricing and capability snapshot

Compare starting price and key capabilities across common eSignature vendors. Verify plan details with each vendor before purchase.

	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	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes (select plans)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA available)	Varies by plan/BAA	Varies by plan/BAA	Varies by plan	Varies by plan

Illustrative scenarios using a Healthcare Doctor Agreement

Real-world examples show how clauses and processes apply in common hiring and contracting situations.

Hospital-employed Physician

A hospital hires a cardiologist for inpatient coverage and outpatient clinic work.

The contract sets call schedule and productivity benchmarks.
The hospital included malpractice minimums, a 60-day termination notice, and an EHR access clause to ensure continuity of care and credentialing compliance.

Locum Tenens Contract

A staffing firm engages a locum for a 90-day assignment covering an understaffed ER.

The agreement defines shift schedule, premium pay, and liability coverage.
The contract used expedited credentialing requirements and a clear indemnification section to manage transient coverage and billing responsibilities.

Practical drafting tips to reduce disputes

Adopt clear language, align contract terms with payer rules, and centralize credentialing documents to speed onboarding.

Be specific

Define clinical duties, measurable productivity metrics, and billing responsibilities to minimize interpretation disputes.

Align with payers

Ensure compensation and billing clauses reflect payer contract requirements to avoid recoupment or audit issues.

Maintain version control

Record effective dates and revisions; keep signed originals and a change log for audit and legal defense.

Document training

Require EHR and compliance training completion and retain certificates as part of the provider file.

Frequently asked questions about Healthcare Doctor Agreements

Answers to common execution, compliance, and operational questions when preparing or signing a Healthcare Doctor Agreement.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are generally legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.
Do I need a BAA for PHI?
Yes. If the vendor or counterparty will create, receive, maintain, or transmit protected health information, a Business Associate Agreement must be in place to meet HIPAA obligations.
When is notarization required?
Most standard employment or service agreements do not require notarization, but state or transaction-specific documents (powers of attorney, some affidavits) may. Verify local notary rules.
What if names differ on documents?
Mismatched provider names across license, W-9, and contract can delay credentialing and payment; correct names to match government-issued credentials.
Can I use remote online notarization?
RON availability varies by state. Where allowed, follow identity-proofing and audio-video record retention rules required by state notary law.
How long keep signed agreements?
Follow retention rules: retain active agreements through the contract term plus at least 3 years, and HIPAA-related documents for 6 years (45 CFR §164.530(j)).

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