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Locum Tenens Agreement

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LOCUM TENENS AGREEMENT

This Locum Tenens Agreement ("Agreement") is entered into between Facility Name: ("Facility") and Locum Physician Name: ("Locum"), effective as of Effective Date: .

Personal Information

Position Information

Assignment Start Date: Assignment End Date (if applicable):

Employment History

Education & Credentials

Professional References

Legal Disclosures & Certifications

At-Will Employment Statement: The Locum's engagement is on an at-will basis where applicable, and either party may terminate assignment in accordance with the Termination provisions of this Agreement. Nothing in this Agreement shall be construed to create an employment relationship for benefits purposes unless expressly stated in writing.

Equal Opportunity Statement: Facility affirms a policy of non-discrimination in hiring and credentialing on the basis of race, color, religion, sex, national origin, disability, age, or any other characteristic protected by applicable law.

Applicant Certification: I certify that all information provided in this Agreement and accompanying credentials is true, complete, and accurate to the best of my knowledge. I understand that falsification or omission may be grounds for termination of assignment and may subject me to professional or legal action.

By initialing and signing below, Locum authorizes Facility and its agents to contact prior employers, licensing authorities, and references and to obtain criminal background checks, professional credential verification, and drug testing as required for assignment. Locum agrees to provide accurate identifying information and to cooperate with credentialing and background screening.

Consent for Background Check: Background check authorized      Consent for Drug Screen: Drug screen authorized

Key Contract Terms

Term: The parties agree that the Locum shall provide services for the Assignment Term specified above. Either party may terminate the assignment for cause immediately upon written notice or without cause upon the notice period specified herein.

Independent Contractor: Locum acknowledges and agrees that Locum is an independent contractor and is not an employee of Facility. Locum is responsible for all federal, state, and local taxes, licensing, and professional liability coverage unless otherwise expressly agreed in writing.

Licensure and Privileges: Locum shall at all times maintain active medical licensure in the applicable state(s) and any privileges required by Facility. Locum shall promptly notify Facility of any change, suspension, restriction, or investigation affecting licensure, privileges, or fitness to practice.

Malpractice Insurance: Locum shall maintain professional liability insurance in the minimum amount of and shall provide certificates of insurance upon request.

Compensation and Invoicing: Facility shall pay Locum at the agreed rate. Locum shall submit itemized invoices in accordance with the billing cycle: . Payment is due within days of receipt of a properly submitted invoice.

Expenses: Facility will/will not reimburse travel and lodging expenses as set forth: subject to prior approval and submission of receipts.

Recordkeeping and Patient Care: Locum shall document all patient encounters in accordance with Facility policy and applicable law. Medical records created during assignment remain the property of Facility and Locum shall cooperate with transitions of care.

Confidentiality: Locum shall maintain the confidentiality of patient information and Facility trade secrets and shall comply with applicable privacy laws and Facility policies. This obligation survives termination of this Agreement.

Termination: Either party may terminate this Agreement for material breach, loss of licensure, failure to obtain or maintain required credentials, conviction of a felony, or for any reason upon days written notice unless immediate termination is warranted.

Indemnification: Each party agrees to indemnify and hold harmless the other for claims arising from its own negligence or willful misconduct. Locum shall indemnify Facility for claims arising from Locum's negligent professional acts to the extent permitted by law.

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state where Facility is located, without regard to conflict of law principles.

Notices: Notices under this Agreement shall be in writing and delivered to the contact information provided by each party. Facility Contact: Contact Phone:

Entire Agreement and Amendment: This Agreement constitutes the entire agreement between the parties with respect to the subject matter and may only be amended in writing signed by both parties.

Acknowledgment and Applicant Authorization

By signing below, Locum certifies the truthfulness of all information provided, consents to credentialing and background investigations, and accepts the terms and conditions of this Agreement.

I authorize prior employers and professional references to release information regarding my professional qualifications and work history: Authorized

Physician Name:

By:

Date:

Facility Name:

By:

Date:

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What a Locum Tenens Agreement Covers

A Locum Tenens Agreement is a short-term professional services contract used when a licensed clinician temporarily covers duties at a facility or for a staffing agency. It allocates responsibilities for scheduling, credentialing, scope of services, compensation, malpractice coverage, licensing verification, credentialing timelines and termination. The agreement clarifies whether the practitioner is an independent contractor or employee for tax and benefits purposes, and it sets dispute resolution, governing law, confidentiality, and data-protection obligations relevant to patient information.

Why a Clear Agreement Matters for Temporary Coverage

A properly drafted Locum Tenens Agreement reduces operational risk by defining duties, coverage limits, payment terms, insurance responsibilities, and data handling. It creates a written record for credentialing, billing, and compliance with state licensure and federal privacy rules such as HIPAA.

Why a Clear Agreement Matters for Temporary Coverage

Who Typically Prepares and Signs These Agreements

Common users include clinicians, staffing agencies, hospital administrators, and practice managers who coordinate temporary coverage.

  • Locum physician or clinician — Signs as the service provider and confirms licensure and insurance details.
  • Staffing or locum agency — Manages assignment logistics, invoicing, and verification for multiple clinicians.
  • Facility administrator — Approves scope of work, access to records, and on-site procedures.

Accurate role definition at signature time reduces later disputes about pay, liability, and credentialing scope.

Core Clauses and Contract Elements to Include

A professional Locum Tenens Agreement should be concise but comprehensive, covering operational, legal, and compliance items that affect both day-to-day coverage and liability allocation.

Parties

Identify the contracting parties, including legal entity names and business addresses, to avoid ambiguity about responsibilities and invoicing.

Scope of Services

Define duties, permitted procedures, on-call obligations, documentation expectations, and any supervisory relationships during the assignment.

Term and Scheduling

Specify the assignment start and end dates, hours, on-call rotation, cancellation notice periods, and processes for extending or reducing coverage.

Compensation

State the rate, method and timing of payment, expense reimbursement, invoice requirements, and dispute resolution for billing discrepancies.

Insurance and Indemnity

Detail required professional liability limits, primary/secondary coverage allocation, tail coverage, and indemnification responsibilities between parties.

Credentialing and Compliance

List required licenses, DEA registration, privileging, background checks, and documentation the practitioner must provide before starting work.

Essential Data Fields to Collect

Practitioner Name: Full legal name as on license
License Number: State license ID and issuing state
DEA Registration: DEA number and expiration date
Insurance Limits: Carrier and limits per occurrence
Assignment Dates: Start and end dates (MM/DD/YYYY)
Facility Details: Facility name and contact person

How to Complete the Agreement, Step by Step

Follow a consistent process: confirm credentials, complete the contract fields, obtain required signatures, and preserve records for compliance and billing.

  • 01
    Collect Docs: Gather license, DEA, CV, and insurance certificates.
  • 02
    Set Dates: Enter assignment start, end, and hours.
  • 03
    Confirm Pay: Agree on rate, invoice schedule, and expenses.
  • 04
    Signed Copies: Obtain signatures and distribute executed copies.

Configuring an Online Signing Workflow

When you complete the agreement electronically, set up fields and authentication to match credentialing and compliance needs.

Field Configuration
Signature Fields Required for all signers; include date and initials fields
Conditional Sections Show malpractice or expense clauses only when applicable
Signer Authentication Use email plus SMS or stronger KBA for identity
Notifications Enable reminders for pending signatures and overdue invoices

Sharing, Signing, and File Formats

Choose a platform that supports PDF and DOCX, secure transmission, and required integrations for HR or billing systems.

  • File Formats: PDF and Word DOCX supported
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Authentication: Email, SMS code, or KBA options

Ensure the chosen platform can produce an audit trail, export signed PDFs, and meet any HIPAA or institutional security requirements.

Typical Route from Draft to Executed Agreement

A predictable flow reduces onboarding time: upload, assign fields, send to signers, confirm identities, capture signatures, and distribute copies.

  • Upload: Add the contract to the signing platform
  • Prepare: Place signature, date, and mandatory fields
  • Send: Email or link the document to signers
  • Archive: Store executed copy with audit trail

Key Timing Considerations and Typical Deadlines

Certain timing elements commonly affect readiness: credentialing lead times, verification windows, and invoice submission deadlines.

Credentialing Lead Time:

Typical 30–90 days to complete privileges and verification

License Verification:

Must be current before first shift; verify immediately

Malpractice Effective Date:

Policy must be active for assignment start date

Cancellation Notice:

Specify required notice, often 7–30 days

Invoice Submission:

State payment window and last day to submit invoices

Milestones from Engagement to Final Closeout

Track these sequential stages to ensure coverage starts on time and invoicing completes without disputes.

01

Engagement Confirmed

Agreement signed and assignment dates set.

02

Credentialing Complete

Licenses and privileges verified before first shift.

03

Coverage Delivered

Clinician performs scheduled shifts and documents care.

04

Final Reconciliation

Finalize invoices, reconcile expenses, and close the assignment.

Common Preparation Errors to Avoid

  • Using incomplete licensure data that delays privileges and prevents clinicians from starting the assignment on the planned date.
  • Failing to confirm professional liability coverage periods, creating gaps where claims could be denied or disputed.
  • Ambiguous compensation language that omits overtime, call pay, or expense reimbursement, leading to billing disputes.
  • Not specifying governing law and dispute resolution, which can increase litigation complexity and costs if a dispute arises.

Short-Form Risk Checklist

HIPAA Exposure: Civil fines possible
Malpractice Gap: Claim denial risk
Tax Misclassification: Back taxes and penalties
Credential Delay: Revenue loss
Contract Breach: Damages and legal fees
Data Loss: Regulatory enforcement risk

Real-World Examples of Digital Execution

These short case snapshots show how online signing reduced turnaround for healthcare agreements.

Optica Ventures — Brian Fitzgibbons

Optica used e-signatures to streamline contracts and onboarding.

  • "The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers."
  • The faster signature process reduced administrative follow-up and improved client satisfaction while keeping executed agreements auditable and retrievable.

Fertility Centers — John Butler

A clinical practice digitized consent and provider agreements to eliminate physical routing.

  • "The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."
  • The change enabled mobile signing during clinic flow, shortened approval times, and centralized secure storage for compliance.

Typical Signers and Their Authority

Locum Clinician

A licensed physician, nurse practitioner, or other clinician who signs as the service provider; attests to current licensure, DEA registration, and professional liability coverage and confirms availability for the assignment.

Facility Representative

Hospital or clinic administrator authorized to accept temporary coverage terms, confirm privileging and access, and approve operational details such as EMR access and shift scheduling on behalf of the facility.

Practical Tips to Reduce Delays and Disputes

Adopt consistent standards that speed onboarding and reduce contractual friction for temporary clinicians.

Standardize a Template
Use a vetted template that includes required credentialing checklists, insurance specifications, and a clear compensation schedule to avoid repeated negotiation and reduce review time.
Pre-Verify Credentials
Complete primary-source verification before circulation; attach digital copies of licenses, DEA, CV, and insurance certificates to the agreement package.
Specify Payment Terms
Define invoice timing, required backup documents, and dispute resolution steps; consider direct deposit or electronic payment instructions to accelerate settlement.
Maintain Audit Trails
Capture signer identity, timestamps, IP addresses, and a certificate of completion to support enforcement and regulatory reviews.

eSignature Vendor Comparison for Locum Tenens Agreements

Compare common eSignature options on price and key capabilities that matter for healthcare contracts and PHI handling. signNow is listed first per table convention.

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 trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

FAQs and Troubleshooting for Locum Tenens Agreements

Answers to common questions about electronic execution, notarization, privacy, and correcting signed documents.


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