Legal Health Agreement

LEGAL HEALTH AGREEMENT

This Legal Health Agreement ("Agreement") is made and entered into as of Effective Date: by and between Provider Name: , and Client Name: . Provider and Client are each a "Party" and together the "Parties."

RECITALS

WHEREAS, Provider is qualified and authorized to provide the health-related services described herein and to coordinate necessary legal and medical documentation; and

WHEREAS, Client desires to engage Provider to perform the services set forth in this Agreement and to permit the limited use and disclosure of Client health information for the purposes described in this Agreement; and

WHEREAS, the Parties intend that their respective obligations comply with all applicable health information privacy and security laws and professional standards governing the provision and exchange of health-related information.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth below, the Parties agree as follows:

1. DEFINITIONS

1.1 "Confidential Information" means all medical, psychological, behavioral, genetic, or other health-related information concerning Client that Provider receives, creates, stores, transmits, or otherwise maintains in connection with this Agreement, including Protected Health Information ("PHI") as defined by applicable law.

1.2 "Services" means the legal-health coordination, consultation, documentation, records review, and related activities described in Section 2.

2. SCOPE OF SERVICES

2.1 Provider shall perform the Services including, but not limited to: evaluation of Client health records; preparation and review of medical-legal documentation; coordination with medical providers for records release; drafting of affidavits or reports summarizing relevant health information; and consultation regarding legal implications of health conditions. Detailed description of Services:

2.2 Provider shall perform Services in accordance with professional standards applicable to Provider's discipline and shall exercise reasonable care, skill and diligence.

3. TERM; TERMINATION

3.1 Term. This Agreement commences on the Effective Date and continues until the completion of the Services or earlier termination in accordance with this Section.

3.2 Termination for Convenience. Either Party may terminate this Agreement for any reason upon Notice delivered in accordance with Section 11 and after providing Notice Period (days):

3.3 Termination for Cause. Either Party may terminate immediately upon material breach by the other Party that remains uncured for thirty (30) days after written notice specifying the breach.

4. COMPENSATION AND PAYMENT

4.1 Fees. Client shall pay Provider the fees set forth below or in an attached fee schedule. Hourly rate: . Flat fee (if applicable): .

4.2 Billing and Payment Terms. Provider will invoice Client monthly or upon completion of Services. Payment is due within days of invoice date. Late payments accrue interest at .

5. CONFIDENTIALITY AND HEALTH INFORMATION

5.1 Confidentiality. Provider shall treat all Confidential Information as confidential and shall not use or disclose such information except as permitted by this Agreement or required by law. Provider shall implement appropriate administrative, physical, and technical safeguards to protect PHI.

5.2 Authorization to Use and Disclose. Client authorizes Provider to access, use, and disclose Client's health information to the extent necessary to perform the Services and to communicate with Client's authorized representatives. Client hereby initials to indicate consent:

5.3 Minimum Necessary. Provider will limit disclosures to the minimum necessary information to accomplish the intended purpose.

6. COMPLIANCE WITH LAWS; PROFESSIONAL STANDARDS

6.1 Each Party shall comply with all applicable statutes, regulations, and professional rules governing the handling of health information, privacy, licensing, and the provision of services under this Agreement.

6.2 Provider represents that it is duly licensed or credentialed where required and will maintain such credentials during the Term.

7. REPRESENTATIONS AND WARRANTIES

7.1 Each Party represents and warrants that it has the full power and authority to enter into this Agreement and to perform its obligations hereunder. Client represents that all information provided to Provider is true and complete to the best of Client's knowledge.

8. INDEMNIFICATION; LIMITATION OF LIABILITY

8.1 Indemnification. Each Party (the "Indemnifying Party") shall indemnify, defend, and hold harmless the other Party and its officers, directors, employees and agents (collectively, the "Indemnified Parties") from and against any third-party claim, loss, liability, damage, cost or expense (including reasonable attorneys' fees) arising out of the Indemnifying Party's breach of this Agreement, negligence, willful misconduct, or violation of law.

8.2 Limitation of Liability. EXCEPT FOR LIABILITY ARISING FROM A PARTY'S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT, IN NO EVENT SHALL EITHER PARTY'S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT EXCEED THE AMOUNTS PAID OR PAYABLE TO PROVIDER UNDER THIS AGREEMENT DURING THE SIX (6) MONTHS PRECEDING THE CLAIM.

9. RECORDS; AUDIT

9.1 Provider shall maintain accurate and complete records relating to the Services and any uses or disclosures of PHI. Such records shall be retained in accordance with applicable law and professional standards.

9.2 Upon reasonable notice, Client or Client's authorized representative may inspect records to the extent required by law, subject to redaction of information protected by other persons' privacy rights.

10. INSURANCE

Provider shall maintain professional liability insurance in an amount sufficient for the Services provided and shall provide proof of insurance upon request.

11. NOTICES

11.1 All notices, consents, approvals and other communications required or permitted under this Agreement shall be in writing and delivered to the Parties at the addresses set forth below or to such other address as either Party may designate by written notice in accordance with this Section.

12. AMENDMENT; WAIVER; COUNTERPARTS

12.1 Amendment. This Agreement may be amended only by a writing signed by both Parties.

12.2 Waiver. A failure or delay by either Party to enforce any right or remedy under this Agreement shall not constitute a waiver of that right or remedy.

12.3 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

13. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

13.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of: , without regard to its conflict of laws principles.

13.2 Entire Agreement. This Agreement, including any attachments or fee schedules incorporated by reference, constitutes the entire agreement between the Parties concerning the subject matter hereof and supersedes all prior negotiations, understandings, or agreements.

13.3 Severability. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect and the invalid or unenforceable provision shall be reformed to the minimum extent necessary to make it enforceable.

14. MISCELLANEOUS

14.1 Assignment. Neither Party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other Party, except that Provider may assign to an affiliate or successor in interest.

14.2 Relationship of Parties. The Parties are independent contractors. Nothing in this Agreement creates a partnership, joint venture, employment relationship or agency between the Parties.

ADDITIONAL INFORMATION

Individual LLC Corporation Other:

CERTIFICATIONS

By signing below, each Party certifies that: (a) the signatory is authorized to execute this Agreement on behalf of the Party; (b) the Party has read and understands the terms of this Agreement; and (c) to the extent applicable, Client authorizes the disclosure and use of health information as set forth herein.

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