Can this agreement be signed electronically?

Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and applicable state UETA or ESRA rules, electronic signatures are legally valid if intent, consent, attribution, and retention are satisfied.

Is a Business Associate Agreement required?

If the physician or nonprofit will create, receive, maintain, or transmit protected health information (PHI), include a HIPAA Business Associate Agreement and ensure HIPAA compliance (45 CFR §164.502 et seq.).

What if the physician's name differs on documents?

Mismatched names can delay payments and credentialing. Update records to match state license and W-9; include a notarized affidavit for name changes when necessary.

Do I need a notary or witnesses?

Generally not required for standard contracts, but some states or specific clauses may require notarization or witnesses—verify state rules and funder requirements.

How long should I keep the executed agreement?

Retain for the active term plus at least three years; HIPAA-covered records require six years (45 CFR §164.530(j)); consult state rules for longer periods.

What happens if PHI is breached?

Follow HIPAA breach notification rules, notify affected individuals and HHS as required, and review indemnity and insurance clauses to determine liability and coverage.

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Physician's Agreement with Non-Profit Corporation

Physician's Agreement with Non-Profit Corporation

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Agreement between Professional Corporation and Non-Profit Corporation to Treat People who cannot Afford Healthcare

Medical services agreement made , between

, with its principal office located at , referred to herein as Corporation,

and , a professional corporation organized and existing under the laws of the state of , with its principal office located at , referred to herein as PC.

Whereas, Corporation was organized for the purpose of securing the benefits of medical and surgical care, nursing and hospitalization to many individuals whose financial condition has made it impossible for them to receive such services in the past, which individuals are referred to in this agreement as patients); and

Whereas, PC is willing to assist in the execution of such corporate purpose in consideration of receiving such fees as the patient is able to pay for the services rendered;

Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows:

1. PC agrees to offer services of its shareholder physicians to those who shall make to Corporation the periodic payments agreed upon by PC and Corporation on the terms and conditions set forth below. This agreement shall constitute an irrevocable offer by PC to such patients for the performance of the services described below.

2. To the extent that PC's services shall have been promised by Corporation to the patient and subject to the terms and conditions set forth in this agreement, PC shall treat all persons who make, or on whose behalf shall have been made, the periodic payments required for such services pursuant to this agreement. PC shall perform such services whether requested to do so by the patient or by the Corporation.

3. PC shall accept in full for PC's services performed under this agreement the fees fixed as set forth in Exhibit A of this agreement.

4. In furtherance of the charitable purposes of Corporation's organization, it shall not receive from PC any sums that PC collects.

5. This agreement may be canceled by either party at any time without cause on days' (written) notice to the other.

6. The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision.

7. The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred.

8. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of .

9. Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement.

10. Mandatory Arbitration

Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect.

11. This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement.

12. Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party.

WITNESS our signatures as of the day and date first above stated.

__________________________

(Name of Corporation)

By: ______________________________

___________________________

(Printed name & Office in Corporation)

____________________________

(Signature of Officer)

__________________________

(Name of PC)

By: ______________________________

___________________________

(Printed name & Office in Corporation)

____________________________

(Signature of Officer)

What the Physician's Agreement with Non-Profit Corporation Is

A Physician's Agreement with Non-Profit Corporation is a written contract that defines the scope, duties, compensation, confidentiality, and term for a physician providing services to a nonprofit entity. It aligns clinical responsibilities with the nonprofit's mission, clarifies liability and indemnity, and sets expectations for schedule, credentialing, and performance. The agreement commonly addresses HIPAA compliance, professional standards, malpractice coverage, termination rights, and disputes. Parties use this document to ensure regulatory compliance, protect patient data, and provide a clear legal basis for payment, reporting, and operational oversight during the physician's engagement.

Why a Clear Agreement Matters for Physicians and Nonprofits

A clear written agreement reduces ambiguity about duties, risk allocation, compensation, and HIPAA responsibilities, making it easier to manage credentialing, billing, and termination. It protects both the nonprofit and the physician by documenting consent, insurance requirements, and recordkeeping obligations under federal and state law.

Who Typically Prepares or Signs This Agreement

Nonprofits and physicians use this agreement to formalize clinical services, whether part-time, contract, or volunteer.

Nonprofit leadership and HR personnel who coordinate clinical programs and supervise compliance and credentialing.
Physicians or their practice managers who need documented terms for compensation, malpractice limits, and schedule expectations.
Legal counsel or outside general counsel who review indemnity, licensing, and state-specific professional practice limitations.

Signed, dated agreements provide enforceable proof of the parties' mutual expectations and support regulatory audits and payer interactions.

Primary Signatory Roles

Nonprofit Executive

Chief Executive Officer or authorized executive signs for the nonprofit, confirming organizational authority, budget approval, and acceptance of contractual obligations tied to program funding and compliance with grant or donor restrictions.

Physician / Provider

The individual physician (or an authorized practice representative) signs to accept scope, compensation, credentialing terms, professional obligations, and HIPAA responsibilities; signatures must match the legal name on licenses and tax documents.

Key Provisions to Include in a Professional Physician's Agreement

A robust agreement organizes operational, legal, and compliance items so the relationship functions smoothly and withstands regulatory review.

Scope of Services

Define clinical duties, patient populations served, on-call expectations, supervisory responsibilities, and any restrictions on outside practice to avoid conflicts with nonprofit mission.

Term and Termination

State the effective date, renewal terms, notice periods, and immediate-termination rights for material breaches, loss of license, or failure to maintain required credentials or insurance.

Compensation

Detail payment method, rate (salary, stipend, fee-for-service), billing responsibilities, expense reimbursement, and procedures for modifications or retroactive corrections.

Insurance and Liability

Specify malpractice insurance minimums, whether the nonprofit or physician provides coverage, indemnity clauses, and how claims will be handled.

Compliance and Privacy

Include HIPAA obligations, Business Associate Agreement references if PHI is exchanged, reporting duties, and data security expectations.

Intellectual Property & Confidentiality

Address ownership of clinical program materials, research output, confidentiality of donor or patient information, and publication or presentation permissions.

Step-by-Step: Completing the Agreement

Follow these steps to create a clean, auditable agreement ready for signature and storage.

01

Prepare Draft: Gather licensure, insurance, and W-9 before drafting core terms.
02

Insert Details: Fill legal names, effective date, term, duties, and compensation accurately.
03

Compliance Review: Have privacy and legal teams confirm HIPAA, credentialing, and indemnity provisions.
04

Sign and Archive: Execute signatures, notarize if required, and store final PDF with audit trail.

How to Configure an Online Signing Workflow

Set up an electronic workflow that enforces signing order, authentication, and document retention before sending for signatures.

Field	Configuration
Signing Order	Nonprofit first, then Physician; allow countersignatures if needed
Authentication	Email plus SMS code for physician; optional ID verification for high-risk roles
Required Fields	Make Effective Date, Compensation, Signatures required
Retention	Enable PDF with audit trail and secure storage

Where to Send or File the Completed Agreement

Route the executed document to internal and external stakeholders and recordkeeping systems to meet operational and legal requirements.

Nonprofit Records: Save signed PDF in the nonprofit's secure document store, tagged by program and fiscal year.
Physician Copy: Provide a signed copy to the physician for credentialing and personal records.
Payroll / Billing: Send compensation terms to payroll or accounts payable for setup.
Compliance Files: Retain any BAA, insurance certificates, and licensure documents with the agreement.

Technical Options for Digital Signing and eSubmission

Choose a platform that supports secure eSignatures, audit trails, and HIPAA-compliant handling when PHI is involved.

Authentication: Email, SMS code, or ID proofing
Document Types: PDF and DOCX supported
Integrations: Link to EHR, HRIS, or document management

Ensure the selected solution provides exportable audit trails, supports BAAs where required, and integrates with the nonprofit's records retention system.

Essential Information Fields to Collect

Physician License: State license number

NPI: National Provider Identifier

Malpractice Coverage: Carrier and policy limits

Tax ID: W-9 requested

Contact Info: Address, email, phone

Emergency Contact: Name and phone

Common Legal Risks and Consequences of Errors

HIPAA Violation: Civil penalties

Insurance Gap: Uncovered claims

Incorrect Payee: Withholding or tax issues

Improper Termination: Breach claims

Missing Signatures: Enforceability risk

Credential Lapse: Regulatory sanctions

Avoid These Frequent Preparation Mistakes

Using informal or unsigned email confirmations instead of a signed agreement creates enforceability gaps.
Failing to attach proof of malpractice coverage and current licenses delays credentialing and can void insurance provisions.
Not including a HIPAA BAA when exchanging PHI increases regulatory and civil risk for the nonprofit.
Leaving compensation formulas vague leads to disputes about billable activities and reimbursement.

Typical Timelines and Administrative Deadlines

Understand these common timing considerations so credentialing, billing, and compliance tasks occur on schedule.

Credentialing Start:

Begin 60–90 days before start date

Insurance Proof:

Provide current certificate before effective date

Tax Documents:

W-9 on file before first payment

Record Retention:

Maintain executed agreement per retention rules

Contract Renewal:

Review 30–60 days before expiration

Real-World Use Cases

These examples show how the agreement is applied in common nonprofit-clinical relationships.

Community Clinic Partnership

A rural nonprofit engages a part-time physician to staff weekly clinics and manage telehealth visits, improving access in underserved areas while documenting schedule and compensation.

Physician provides telehealth and in-person shifts four hours weekly.
The executed agreement included BAA language, specified malpractice limits, and required proof of active state licensure and DEA registration, enabling timely credentialing and payer enrollment.

Volunteer Medical Director

A nonprofit names a volunteer physician as medical director to set protocols and oversee care quality, with limited compensation and clear liability allocation.

Role includes policy oversight and quarterly site visits.
The contract clarified indemnity, limited duties to nonprofit programs, and required the nonprofit to maintain front-line medical malpractice coverage during the volunteer term to prevent coverage gaps.

eSignature Vendor Comparison for Agreement Execution

Compare common eSignature providers on price and compliance features relevant to physician agreements with PHI; signNow is listed first per vendor comparison standards.

	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 plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	Limited
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

Best Practices for Accurate and Efficient Completion

Apply these practices to reduce errors, speed credentialing, and keep the agreement enforceable.

Verify Legal Names

Match the physician's name to state license, NPI, and W-9 records to avoid payment and credentialing delays.

Attach Supporting Documents

Include current malpractice certificate, license copies, DEA, and W-9 with the signed agreement to streamline onboarding.

Use Clear Compensation Terms

Spell out rates, billing codes, reimbursement timing, and adjustments to prevent disputes.

Preserve Audit Trails

Store signed PDFs with time-stamped audit logs and secure backups to meet compliance and audit requests.

Frequently Asked Questions and Troubleshooting

Answers to frequent questions about execution, enforceability, and compliance when creating or signing a Physician's Agreement with Non-Profit Corporation.

Need help? Contact support

Can this agreement be signed electronically?
Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and applicable state UETA or ESRA rules, electronic signatures are legally valid if intent, consent, attribution, and retention are satisfied.
Is a Business Associate Agreement required?
If the physician or nonprofit will create, receive, maintain, or transmit protected health information (PHI), include a HIPAA Business Associate Agreement and ensure HIPAA compliance (45 CFR §164.502 et seq.).
What if the physician's name differs on documents?
Mismatched names can delay payments and credentialing. Update records to match state license and W-9; include a notarized affidavit for name changes when necessary.
Do I need a notary or witnesses?
Generally not required for standard contracts, but some states or specific clauses may require notarization or witnesses—verify state rules and funder requirements.
How long should I keep the executed agreement?
Retain for the active term plus at least three years; HIPAA-covered records require six years (45 CFR §164.530(j)); consult state rules for longer periods.
What happens if PHI is breached?
Follow HIPAA breach notification rules, notify affected individuals and HHS as required, and review indemnity and insurance clauses to determine liability and coverage.

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