Can this agreement be signed electronically?

Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the four-part e-sign validity test is met: intent, consent, attribution, and retention.

Is notarization or witnesses required?

Not normally required for employment or independent contractor contracts, but some states or facility policies may request notarization or witnesses; check state rules and facility credentialing requirements.

How do I handle protected health information?

Include a Business Associate Agreement and limit PHI exchange to the minimum necessary; comply with HIPAA privacy and security rules and retain documentation for six years.

Who should sign on behalf of the facility?

An authorized representative such as a director of clinical operations, CNO, or an executive with delegated signing authority should sign; confirm signing authority in facility policy.

How can the agreement be revoked or amended?

Follow the amendment and termination clauses in the agreement; written amendments signed by all parties are recommended. For revocation prior to start, document notice in writing and confirm return of any advance payments.

How long should I retain the executed agreement?

Retain for at least three years after termination for general records, six years for HIPAA-covered documentation, and longer if claim exposure exists; consult counsel for state-specific requirements.

Electronic Signature
Templates
Healthcare
Healthcare Locum Tenens Services Agreement

Healthcare Locum Tenens Services Agreement

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

HEALTHCARE LOCUM TENENS SERVICES AGREEMENT

This Healthcare Locum Tenens Services Agreement (the Agreement) is entered into by and between Facility Name: located at Facility Address: (hereafter "Facility"), and Locum Tenens Practitioner: (hereafter "Practitioner").

RECITALS

WHEREAS, Facility requires temporary clinical services in the specialty of Specialty: ; and WHEREAS, Practitioner represents that Practitioner holds all necessary licenses, certifications, qualifications and privileges to provide such services.

TERM AND SCOPE OF SERVICES

Effective Date: The Practitioner shall provide locum tenens clinical services at Facility during the period Start Date: through End Date: , unless earlier terminated in accordance with this Agreement.

RESPONSIBILITIES AND PERFORMANCE

Practitioner shall render professional services consistent with the standard of care for the specialty and all applicable laws, regulations, Facility policies, and medical staff bylaws. Practitioner shall provide services at the following Facility locations and departments:

CREDENTIALING, LICENSES AND VERIFICATIONS

Practitioner shall maintain all required licenses, DEA registrations, board certifications and privileges. Practitioner consents to Facility performing credentialing, background checks, and verification of credentials. Credentialing completion date required by Facility:

Background checks and screenings required

Background check Drug screen Immunizations and TB screening

COMPENSATION, BILLING AND PAYMENT

Rate and payment terms Base rate Overtime / call pay (if applicable) Travel, lodging and per diem

Invoicing frequency: . Payment terms: Net days from receipt of undisputed invoice. All invoices shall include time records and supporting documentation as required.

INSURANCE AND INDEMNIFICATION

Practitioner shall maintain professional liability insurance with minimum limits of and shall provide certificates of insurance naming Facility as an additional insured where required. Practitioner shall defend, indemnify and hold Facility harmless from claims arising from Practitioner's negligent acts, omissions, or breach of this Agreement, except to the extent caused by Facility's gross negligence or willful misconduct.

INDEPENDENT CONTRACTOR STATUS

Practitioner is engaged as an independent contractor. Practitioner is responsible for all taxes, withholdings, benefits and other obligations. Nothing in this Agreement shall create an employment, partnership or joint venture relationship.

CONFIDENTIALITY AND HIPAA COMPLIANCE

Practitioner shall comply with all federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), and with Facility policies concerning protected health information. Practitioner shall use and disclose PHI only as permitted for treatment, payment and healthcare operations, and shall implement safeguards to prevent unauthorized disclosure. Breach notification to Facility shall be provided by Practitioner within of discovery.

MEDICAL RECORDS AND PATIENT CARE

Practitioner shall complete and maintain all required medical records contemporaneously and in accordance with Facility policy. Practitioner authorizes Facility to access Practitioner's clinical records generated under this Agreement for quality assurance and billing purposes. Practitioner shall cooperate with record requests and chart audits.

REPRESENTATIONS, WARRANTIES AND COVENANTS

Practitioner represents and warrants that Practitioner: (a) holds all licenses, registrations and privileges necessary to perform the Services; (b) has not been excluded from participation in any federal or state healthcare program; and (c) will notify Facility promptly of any change in status. Facility represents that it will provide appropriate facilities, support staff and access to medical records as reasonably necessary for Practitioner to perform services.

TERMINATION

This Agreement may be terminated by either party for convenience upon written notice of days. Immediate termination may occur for cause, including loss of license, suspension of privileges, criminal conviction, or material breach. Upon termination, Facility shall pay Practitioner for undisputed services performed through the termination date.

NON-SOLICITATION

During the Term and for a period of months following termination, neither party shall directly solicit employees or independent contractors of the other party for employment without prior written consent, except responding to general solicitations.

FORCE MAJEURE

Neither party shall be liable for delays or failure to perform due to causes beyond its reasonable control, including acts of God, pandemics, government restrictions, or labor disputes. The affected party shall notify the other promptly and make reasonable efforts to resume performance.

DISPUTE RESOLUTION; GOVERNING LAW

The parties shall attempt in good faith to resolve disputes through negotiation. If unresolved within 30 days, disputes shall be submitted to binding arbitration in the county where Facility is located, and governed by the laws of the state of Governing Law State: , without regard to conflict of law principles.

NOTICES

Facility notice contact Practitioner notice contact

AUTHORIZATION TO ACCESS MEDICAL RECORDS (IF REQUIRED)

Practitioner authorizes Facility and its authorized agents to access and copy medical records and other clinical documentation necessary for billing, credentialing and quality review purposes. This authorization shall expire on Authorization Expiration Date: unless earlier revoked in writing.

MISCELLANEOUS

This Agreement constitutes the entire agreement between the parties and supersedes all prior agreements regarding the subject matter. Amendments must be in writing and signed by authorized representatives of both parties. Neither party may assign this Agreement without the prior written consent of the other, except that Facility may assign to an affiliate or successor entity.

ADDITIONAL TERMS

Additional provisions or special instructions

Facility (Client) Printed Name:

By:

Date:

Locum Tenens Practitioner Printed Name:

By:

Date:

What the Healthcare Locum Tenens Services Agreement Is

A Healthcare Locum Tenens Services Agreement is a contract that sets out the temporary placement of a physician, advanced practice provider, or other licensed clinician at a healthcare facility. It defines scope of services, assignment dates and shifts, compensation and billing, licensing and credentialing obligations, insurance and indemnity requirements, confidentiality and HIPAA protections, and termination rights. The agreement creates a binding relationship for a defined term and typically requires verification of malpractice coverage, state licensure, and any facility-specific privileging before the clinician begins patient care.

Why this Agreement Matters for Staffing and Compliance

Using a written locum tenens agreement clarifies expectations, reduces credentialing and liability gaps, and documents payment and malpractice responsibilities. It helps maintain continuity of care, meets payer and facility requirements, and supports compliance with HIPAA and state licensing rules.

Who typically completes and relies on this agreement

Each party should retain a fully executed copy and ensure credentialing and insurance documents are attached before the assignment start date.

Hospitals and health systems hiring short-term clinical coverage.
Locum tenens agencies and independent clinicians coordinating assignments.
Practice managers and credentialing offices responsible for privileging.

Representative signer profiles

Locum Clinician

A physician or allied health professional contracted to provide temporary clinical services; signs to accept assignment terms, confirms licensure and malpractice coverage, and agrees to confidentiality and applicable facility rules.

Facility Administrator

A hiring manager, director of clinical operations, or credentialing officer authorized to bind the facility; signs to confirm scope of work, payment terms, privileged status, and supervision requirements.

Core elements to include in a professional agreement

A comprehensive locum agreement balances operational detail with legal protections to limit disputes and ensure patient safety.

Scope of Services

Describe duties, settings, on-call expectations, and any supervisory or collaborative practice limits tied to state law and facility policy.

Term and Schedule

Specify start and end dates, daily shift times, grace periods, and procedures for extending or terminating the assignment.

Compensation

State rate, payment schedule, invoicing requirements, expense reimbursement, and how taxes or 1099 reporting will be handled.

Credentialing and Privileges

Require proof of state license, DEA registration if applicable, facility privileging, background checks, and immunization status.

Insurance and Indemnity

Detail required malpractice limits, primary vs. secondary coverage, indemnification clauses, and notice procedures for claims.

Confidentiality and Compliance

Include HIPAA safeguards, patient privacy obligations, breach notification, and any required business associate agreement (BAA).

Security and compliance items to confirm

HIPAA BAA: Required for PHI exchange

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encrypted storage

Audit Trail: Timestamped signing records

Access Controls: Role-based user permissions

21 CFR Readiness: Consider for FDA-regulated studies

Step-by-step: completing the agreement

Follow these sequential actions to complete, sign, and store a locum agreement accurately.

01

Gather required documents: Collect license, DEA, CV, and malpractice certificate.
02

Populate agreement fields: Enter parties, effective date, scope, and rates.
03

Add attachments: Attach credentialing and insurance documentation.
04

Execute and archive: Obtain signatures, distribute copies, and store securely.

Typical routing and signing workflow

A common workflow reduces delays by sequencing credential verification before final signature.

Upload agreement: Place the template and required attachments in the system.
Assign fields: Place signature, date, and checkbox fields for each signer.
Send to signers: Deliver via email link or secure portal.
Store executed copy: Save signed PDF with audit trail.

Recommended electronic workflow settings

Configure the digital workflow to require key verifications before signatures are allowed.

Field	Configuration
Authentication	Email link with optional SMS code
Reminders	Auto-reminders at 3 and 7 days
Conditional Fields	Show privileged sections after credential upload
Retention	Save signed PDF + audit trail indefinitely

Technical requirements for e-signing and storage

Ensure the vendor offers HIPAA-capable features, audit logging, and exportable signed documents for your records and compliance reviews.

File formats: PDF and DOCX supported
Integrations: Connectors for Salesforce and NetSuite
Authentication: Email, SMS, or stronger methods

Key deadlines and timing expectations

Track credentialing and tax deadlines to avoid coverage gaps and reporting penalties.

Credentialing lead time:

Allow 2–6 weeks for privileging and background checks

Start-date verification:

Confirm licenses and insurance before first shift

I-9 completion:

Complete Form I-9 within three business days of hire (8 CFR)

1099-NEC reporting:

Issue to contractors by Jan 31 for tax reporting

Contract extensions:

Document and sign any extensions before original end date

Milestones from request to closeout

Use a milestone timeline to coordinate credentialing, assignment, and final reconciliation.

01

Request and approval

Define need and secure budget approval before outreach

02

Credentialing completion

Verify licenses, privileges, and malpractice prior to scheduling

03

Assignment start

Confirm on-call and shift details with clinician

04

Post-assignment closeout

Reconcile billing, collect final reports, and retain records

Common preparation and execution mistakes

Delaying credentialing until after start date creates coverage risk and compliance gaps.
Failing to attach malpractice certificate or incorrect policy limits prevents proof of coverage.
Leaving compensation terms vague (e.g., 'reasonable rate') leads to disputes and delayed payments.
Not specifying governing law and dispute resolution increases litigation unpredictability for cross-state assignments.

Key legal and financial risks to address

HIPAA fines: Potential civil penalties and corrective action

Licensure violations: State board sanctions or practice restrictions

Indemnity exposure: Uninsured claims if coverage is insufficient

Tax penalties: Backup withholding or information return fines

Contract disputes: Damages, fees, and operational disruption

Delay costs: Lost revenue from unfilled shifts

eSignature vendor pricing and feature snapshot

Basic pricing and core features differ across vendors; signNow is presented first for comparison purposes without suggesting a recommendation.

	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 free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes (premium plans)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA available)	Yes	Yes	No	No

Frequently asked questions and quick answers

Answers to common execution, compliance, and signing questions for Healthcare Locum Tenens Services Agreements.

Need help? Contact support

Can this agreement be signed electronically?
Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the four-part e-sign validity test is met: intent, consent, attribution, and retention.
Is notarization or witnesses required?
Not normally required for employment or independent contractor contracts, but some states or facility policies may request notarization or witnesses; check state rules and facility credentialing requirements.
How do I handle protected health information?
Include a Business Associate Agreement and limit PHI exchange to the minimum necessary; comply with HIPAA privacy and security rules and retain documentation for six years.
Who should sign on behalf of the facility?
An authorized representative such as a director of clinical operations, CNO, or an executive with delegated signing authority should sign; confirm signing authority in facility policy.
How can the agreement be revoked or amended?
Follow the amendment and termination clauses in the agreement; written amendments signed by all parties are recommended. For revocation prior to start, document notice in writing and confirm return of any advance payments.
How long should I retain the executed agreement?
Retain for at least three years after termination for general records, six years for HIPAA-covered documentation, and longer if claim exposure exists; consult counsel for state-specific requirements.

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