Can this agreement be signed electronically?

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

Is a BAA required when PHI is involved?

Yes. If the platform or vendor will store or transmit PHI, a Business Associate Agreement is required under HIPAA and must be in place before PHI is processed.

Do I need a notary or witnesses?

Most employment or placement agreements do not require notarization; state rules vary and certain states may require witnesses for specific acknowledgements—verify local law.

How do I amend an executed agreement?

Amendments should be in writing, signed by authorized parties, reference the original agreement, and state effective dates; e-signed amendments follow the same ESIGN/UETA rules.

How long should I keep executed records?

Retain agreements for at least three years for tax/audit purposes and six years for HIPAA-related records (45 CFR §164.530(j)); adjust for state-specific requirements.

What if the signer name doesn't match ID?

Name mismatches can delay credentialing and payment; correct names before signing or include verified alias documentation to maintain attribution and intent.

Electronic Signature
Templates
Healthcare
Healthcare Locums TC Agreement

Healthcare Locums TC Agreement

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

HEALTHCARE LOCUMS TC AGREEMENT

Parties and Engagement

This Healthcare Locums Terms and Conditions Agreement (the Agreement) is entered into between Facility / Agency Name: (hereinafter "Facility") and Locum Provider Name: (hereinafter "Provider").

Facility / Agency Address Provider Address

Facility Contact Name & Phone Provider Contact Phone & Email

Assignment Details

Assignment Location / Department:

Assignment Start Date: Assignment End Date:

Clinical Specialty / Services to be Performed Expected Schedule / Shifts (include hours)

Compensation and Expenses

Provider Rate (hourly or daily): Overtime Rate (if applicable):

Call / On‑Call Pay: Per Diem (if provided):

Travel and Lodging Reimbursement (terms) Expense Authorization Thresholds

Insurance, Credentialing and Compliance

Provider shall maintain licensure and credentials required to perform services. Provider License Number: State of Issue:

NPI Number: DEA Number (if applicable):

Malpractice Insurance (select applicable)

Agency/Facility will provide malpractice coverage Provider will provide own malpractice coverage

If Provider‑Provided: Carrier, Policy No., Limits

Invoicing, Payment and Taxes

Provider shall submit invoices in accordance with the billing schedule. Invoices submitted by Provider to Facility shall include dates of service, hours, rates, and substantiating documentation. Payment Terms: ; Payable To:

Provider acknowledges status as an independent contractor and that Facility will not withhold taxes. Provider Tax ID / SSN (for payment records):

Representations, Warranties and Compliance

Provider represents and warrants that Provider is properly licensed, has full authority to contract, has not been excluded from federal or state health programs, and will comply with all applicable laws and Facility policies. Provider shall promptly disclose any disciplinary actions or restrictions.

Background Checks, Drug Screening and Immunizations

Confidentiality, Privacy and HIPAA

Provider shall safeguard protected health information in accordance with applicable privacy laws. Provider agrees to execute any additional confidentiality or business associate agreements required by Facility and to receive only the minimum necessary patient information to perform services.

Indemnification and Liability

Each party shall indemnify, defend and hold harmless the other party and its officers, employees and agents from claims arising out of the indemnifying party's negligent acts, omissions or willful misconduct; provided liability shall be subject to applicable malpractice insurance and limits set forth in this Agreement.

Termination

This Agreement may be terminated by either party for convenience upon days' written notice. Facility may immediately terminate for cause for violation of law, loss of license, or breach of material obligations.

Governing Law and Dispute Resolution

This Agreement shall be governed by the laws of the state of: . Disputes shall be resolved by binding arbitration unless otherwise agreed in writing.

Notices

All notices shall be delivered to the following addresses for each party:

Facility Notice Contact & Address Provider Notice Contact & Address

Miscellaneous

This Agreement constitutes the entire understanding between the parties related to the subject matter and supersedes all prior agreements. Amendments must be in writing and signed by both parties.

Additional Terms / Special Conditions

Facility / Agency:

By:

Date:

Provider:

By:

Date:

What the Healthcare Locums TC Agreement Is

The Healthcare Locums TC Agreement is a written contract that sets terms for temporary clinical staffing engagements between a locum provider and a facility or staffing agency. It covers assignment scope, hours, compensation, credentialing responsibilities, malpractice insurance, confidentiality of patient information, and acceptance procedures. The agreement clarifies payment cadence, timekeeping and timesheet submission, termination rights, and obligations for maintaining licenses and regulatory compliance while the locum assignment is active. It is used to reduce billing disputes and document compliance requirements for short-term clinical coverage.

Why a Clear Locums TC Agreement Matters

A precise TC agreement reduces payment and liability uncertainty, ensures credentialing and HIPAA obligations are assigned, and protects both the facility and the locum provider by documenting expectations for schedule, compensation, and required documentation.

Who typically completes or relies on this agreement

The document is used across clinical sites and staffing organizations to formalize temporary coverage terms before work begins.

Hospitals and clinics that need time-limited clinical coverage and documented liability and credentialing terms.
Staffing agencies that place locum clinicians and need standardized terms for billing and insurance.
Locum providers (physicians, nurse practitioners, CRNAs) who require clear payment, schedule, and scope-of-practice terms.

Properly completed agreements streamline onboarding, reduce disputes, and support audits for payroll, tax, and credentialing reviews.

Representative signatories and roles

Locum Clinician

A licensed provider (physician, NP, PA) who signs to accept assignment terms, certify credentials, and agree to confidentiality and scope-of-practice limitations; signature confirms intent and consent to electronic recordkeeping.

Facility Representative

An authorized administrator or staffing manager who binds the hiring site to payment terms, work schedule, indemnity clauses, and confirms acceptance of the clinician's credentials under the facility's privileging processes.

Core sections to include in a professional TC agreement

A robust Healthcare Locums TC Agreement organizes assignment, compensation, credentialing, insurance, compliance, and termination provisions so both parties understand obligations and remedies.

Assignment Details

Specify location, dates, shift times, on-call expectations, and any mandatory orientation or credentialing steps required before first shift.

Compensation Terms

Define hourly/daily rates, overtime rules, travel and lodging reimbursements, invoicing cadence, and required documentation for expense reimbursement.

Scope of Services

Describe permitted clinical activities, supervisory relationships, charting responsibilities, and limits on procedures or duties outside the clinician's privileges.

Credentialing & Verification

State who verifies licenses, DEA registration, board certification, malpractice history, background checks, and required completion deadlines before clinical work.

Insurance & Liability

Allocate malpractice coverage responsibilities, minimum coverage amounts, indemnification language, and procedures for reporting incidents or claims.

Termination & Remedies

Explain early termination rights, notice periods, final reconciliation of pay, and dispute-resolution processes including governing law.

Key compliance and security items to record

Protected Health Information: Identify PHI-handling rules

BAA Required: Business Associate Agreement required

Encryption: TLS and AES-256 protections

Audit Trail: Signed timestamps and logs

Access Controls: Role-based signer authentication

Retention: Record retention policy stated

Step-by-step: completing the Locums TC Agreement

Follow these sequential steps to gather documents, complete fields, and finalize an enforceable agreement before clinical work begins.

01

Gather Credentials: Collect license, DEA, NPI, malpractice proof.
02

Complete Agreement: Enter provider and assignment details precisely.
03

Attach Documents: Upload scans of IDs and insurance certificates.
04

Sign & Distribute: Obtain signatures, distribute final executed copy.

How to set up an online signing workflow

Configure authentication, required fields, and document routing to capture valid electronic signatures and preserve audit records.

Field	Configuration
Signer Authentication	Email plus SMS code or ID verification
Required Attachments	License, DEA, malpractice certificate PDFs
Routing Order	Agency → Facility → Provider sequential signing
Audit Capture	Enable IP, timestamp, and certificate logs

Digital signing and platform considerations

Use a platform that supports secure eSignatures, audit trails, and HIPAA-compliant workflows if PHI will be handled or stored.

File Formats: PDF and DOCX supported
Integrations: Works with EHR and payroll systems
Accessibility: Mobile and desktop signing

Ensure Business Associate Agreement availability, encryption at rest and in transit, and retention capabilities that meet healthcare and payroll recordkeeping rules.

Where to send completed agreements

Send executed copies to all parties and to systems used for payroll, credentialing, and HR so records align for billing and compliance.

Staffing Agency: Keeps master placement and invoice records.
Facility HR: Adds to personnel and privileging files.
Credentialing Vendor: Receives license and background documentation.
Payroll: Receives finalized timesheets and compensation terms.

Common timelines and processing expectations

Track key dates for credentialing, timesheet submission, and payroll reconciliation to avoid payment delays and compliance gaps.

Credential Verification Deadline:

Complete verification at least 3–5 business days before first shift.

License Expiration Check:

Confirm active license at assignment start and periodically during long-term placements.

Timesheet Submission:

Submit within 7 days after shift end to meet payroll cutoffs.

Payroll Processing Cutoff:

Observe employer payroll deadlines for inclusion in next pay cycle.

Tax Form Timing:

Retain payment records to meet IRS reporting and withholding requirements.

Common mistakes to avoid when preparing the agreement

Failing to verify active license or DEA registration before the first scheduled shift, which can stop clinical work and create liability.
Leaving compensation terms vague (e.g., 'reasonable rate') instead of specifying per-hour or per-shift amounts and overtime multipliers.
Not attaching required insurance certificates or malpractice limits, leading to payment holds or coverage disputes.
Using unsigned or partially signed copies for onboarding, which can create payroll and credentialing rejections.

Short-term risks and potential penalties

Payment Disputes: Delayed or withheld pay

Tax Withholding: Incorrect classification triggers penalties

Credential Delays: Assignment cancellation risk

HIPAA Fines: Civil penalties for PHI breaches

Contract Voidance: Noncompliance can invalidate terms

Litigation Exposure: Potential for malpractice suits

eSignature vendor comparison for Healthcare Locums TC Agreement workflows

Compare core pricing and compliance capabilities; signNow appears first for baseline cost and HIPAA capability comparison without implying endorsement.

	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 (Business Premium)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
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

FAQs and troubleshooting for Healthcare Locums TC Agreements

Answers to common questions about signing, HIPAA handling, notarization, amendments, and record retention for locum engagements.

Need help? Contact support

Can this agreement be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and retention requirements are met.
Is a BAA required when PHI is involved?
Yes. If the platform or vendor will store or transmit PHI, a Business Associate Agreement is required under HIPAA and must be in place before PHI is processed.
Do I need a notary or witnesses?
Most employment or placement agreements do not require notarization; state rules vary and certain states may require witnesses for specific acknowledgements—verify local law.
How do I amend an executed agreement?
Amendments should be in writing, signed by authorized parties, reference the original agreement, and state effective dates; e-signed amendments follow the same ESIGN/UETA rules.
How long should I keep executed records?
Retain agreements for at least three years for tax/audit purposes and six years for HIPAA-related records (45 CFR §164.530(j)); adjust for state-specific requirements.
What if the signer name doesn't match ID?
Name mismatches can delay credentialing and payment; correct names before signing or include verified alias documentation to maintain attribution and intent.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now