Fill and Sign the Verbatim Reporter Form

Contract with Verbatim Reporter and Transcriber of Medical Records (Proofreading not the Responsibility of Transcriber) Agreement made on the _____ day of ___________________________, 20____, between _____________________________________ (Name of Transcriber) of ________________________________________________________________________ ________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Contractor , and _________________________________________ (Name of Professional Corporation) , a professional corporation organized and existing under the laws of the state of ____________________________ (name of state) , with its principal office located at ________________________________________________________________________ ________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Company . Whereas, Contractor is now and has been for some time engaged in the business of verbatim reporting and the transcription medical records; and Whereas, Company would like to retain the services of Contractor ; 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. Services to be Performed Contractor shall perform the following described transcription work for Company: (Describe transcription work to be done) _____________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Compensation Company shall pay the Contractor for such transcription work as follows: (e.g., amount, payment date, place of payment) _____________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Term of Employment This Agreement shall be in effect for a period of ______ ( number) months from the effective date stated above and shall be renewed and continued in effect for a like period unless either party gives written notice to the other of the desire not to so renew and extend, which notice shall be given not less than ______ ( number) days before the day of expiration. 4. Contractor is Independent Contractor The parties intend that an independent contractor-employer relationship will be created by this Agreement . Company is interested only in the results to be achieved and the conduct and control of the work will lie solely with Contractor . Contractor is not to be considered an agent or employee of Company for any purpose and Contractor is not entitled to any of the benefits that Company provides for Company’s employees. It is understood that Contractor is free to contract for similar services to be performed for others while under contract with Company. 5. Confidentiality Contractor acknowledges and agrees that all records, lists and information pertaining to clients and files and other Company data and information related to its business and patients (hereinafter collectively Confidential Information ) are valuable assets of Company. Except for disclosures required to be made to perform the duties pursuant to this agreement and information which is a matter of public record, Contractor shall not, during the term of this Agreement or after the termination of this Agreement, disclose any Confidential Information to any person or use any Confidential Information for the benefit of Contractor or any other person, except with the prior written consent of Company . Company understands that certain Confidential Information may be required to be disclosed to certain individuals: directors, officers, employees, agents, or advisors (collectively, Representatives) of Contractor . Contractor will inform all such persons of the confidential nature of the information, will direct them to treat such information in accordance with this agreement, will exercise such precautions or measures as may be reasonable in the circumstances to prevent improper use of Confidential Information by them, and will be responsible for any breaches by them of the provisions of this agreement. The term confidential information does not include information that is or becomes publicly available (other than through breach of this Agreement) or information that is or becomes available to Contractor on a non- confidential basis. In the event that Contractor or any of Contractor ’s representatives, assigns, or agents are requested or required by law or legal process to disclose any of the Confidential Information, the party required to disclose such information shall provide Company with prompt oral and written notice before making any disclosure. In addition, Confidential Information may be disclosed to the extent required in the course of inspections or inquiries by federal or state regulatory agencies to whose jurisdiction C ontractor is subject and that have the legal right to inspect the files that contain the Confidential Information , and Contractor will advise Company promptly upon such disclosure. 6. Assignment of Contract Neither of the parties may assign this Agreement or any rights under the Agreement without the prior written consent of the other party. 7. Governing Law The parties agree that this Agreement shall be governed by and construed pursuant to the laws of _____________________________________ ( state) . 8. Entire Agreement This Agreement is the complete and exclusive statement of the mutual understanding of the parties. This Agreement supersedes and cancels all previous written and oral agreements and communications between the parties relating to the subject matter of this Agreement. 9. Amendment The parties agree that they may amend this Agreement only by a written agreement duly executed by persons authorized to execute agreements on behalf of the parties. 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. Disclaimer as to Proofreading This agreement only deals with the transcription of medical records and not the proofreading of same. Company agrees that the responsibility for proofreading the transcriptions of the records shall be its sole responsibility. WITNESS our signatures as of the day and date first above stated. ____________________________________ (Name of Professional Corporation) _______________________________ By: _____________________________ (Name of Contractor) ____________________________________ (Name and Office in Company)