Healthcare Lab Service Agreement

HEALTHCARE LAB SERVICE AGREEMENT

This Healthcare Lab Service Agreement (Agreement) is made and entered into by and between Laboratory Name: (Laboratory) and Client Name: on Effective Date: .

PARTIES AND CONTACT INFORMATION

SCOPE OF SERVICES

Laboratory will provide clinical laboratory testing and services as described below. Laboratory shall perform tests in accordance with accepted professional standards, applicable accreditation requirements, and the test menu designated by the parties.

Standard Turnaround Time (TAT): . Expedited or STAT requests and associated fees must be approved in writing prior to testing.

SPECIMEN COLLECTION, HANDLING, AND CHAIN OF CUSTODY

Client is responsible for proper specimen collection, labeling, preservation, and transport in accordance with Laboratory instructions. Client shall complete and transmit required chain of custody and requisition documentation for each specimen.

Chain-of-custody required: Yes No

FEES, BILLING, AND PAYMENT

Laboratory shall invoice Client for services rendered pursuant to the Fee Schedule agreed by the parties. Fees for tests, supplies, and shipping are due in accordance with the Billing Terms below.

Payment Terms: Net 30 Net 45 Prepaid

INSURANCE, CODING AND CLAIMS

Client is responsible for providing accurate insurance and patient billing information. Laboratory will submit claims only with explicit prior agreement. Laboratory makes no guarantee of reimbursement and Client is responsible for unpaid balances unless otherwise agreed in writing.

CONFIDENTIALITY, PHI AND HIPAA COMPLIANCE

The parties acknowledge that testing may require the disclosure of Protected Health Information (PHI). Each party shall comply with applicable privacy and security laws governing PHI. Laboratory shall act as a Business Associate where required and implement appropriate administrative, physical, and technical safeguards to protect PHI.

Client represents and warrants it has authority under applicable law to disclose patient identifiers and PHI to Laboratory for the purpose of testing and has obtained all required consents and authorizations. Client affirms

QUALITY ASSURANCE, ACCREDITATION, AND AUDIT

Laboratory shall maintain all required licenses, certifications, and accreditations necessary to perform the agreed testing. Laboratory shall allow Client to perform on-site audits with reasonable prior notice and subject to confidentiality obligations.

INDEMNIFICATION AND LIMITATION OF LIABILITY

Each party shall indemnify, defend, and hold harmless the other party from claims, liabilities, losses, and expenses arising from that party's negligence, willful misconduct, or breach of this Agreement. Except for liability arising from gross negligence or willful misconduct, Laboratory's aggregate liability for claims arising under this Agreement shall not exceed the total fees paid by Client to Laboratory under this Agreement in the preceding twelve (12) months.

TERM, TERMINATION, AND SURVIVAL

This Agreement shall commence on the Effective Date and continue until terminated by either party upon written notice as provided below. Termination shall not affect obligations incurred prior to termination. The obligations that by their nature survive termination shall survive as specified herein.

INSURANCE

Each party shall maintain commercial general liability and professional liability insurance with limits sufficient to cover its obligations under this Agreement. Upon request, each party shall provide certificates of insurance to the other.

DATA REPORTING, OWNERSHIP, AND RECORDS

Laboratory shall provide test reports to Client in a secure format agreed by the parties. Laboratory retains ownership of raw testing data and analytic methods, except to the extent Patient Identifiers or PHI are subject to disclosure; Client retains ownership of patient records and PHI. Laboratory shall retain records in accordance with applicable law and provide copies upon reasonable request.

GOVERNING LAW AND DISPUTE RESOLUTION

This Agreement shall be governed by and construed in accordance with the laws of the governing jurisdiction below. The parties shall attempt in good faith to resolve disputes through negotiation prior to initiating litigation.

NOTICES

All notices required under this Agreement shall be given in writing to the contact addresses set forth below.

MISCELLANEOUS PROVISIONS

This Agreement constitutes the entire agreement between the parties concerning the subject matter and supersedes prior agreements. Amendments must be in writing and signed by authorized representatives. If any provision is invalid, the remainder shall remain in effect.

SAMPLE SUBMISSION — PATIENT INFORMATION (AS APPLICABLE)

INSURANCE AND MEDICAL HISTORY (IF BILLING PATIENT)

ACKNOWLEDGMENTS

By signing below, the undersigned represent and warrant that they are authorized to execute this Agreement on behalf of their respective organizations and acknowledge acceptance of the terms and conditions set forth herein.

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