Physician Professional Services Agreement Template

A Physician Professional Services Agreement is a legally binding contract that outlines the terms and conditions of a professional relationship between a physician and a client. This agreement is crucial for establishing clear expectations, protecting the interests of both parties, and ensuring a smooth and successful professional engagement.

Scope of Services

This section should clearly define the specific services the physician will provide. Avoid vague or ambiguous language. Be precise in describing the services included, such as:

Medical consultations: This could include in-person, telemedicine, or written consultations.

Diagnostic services: Specify which diagnostic tests the physician will order or interpret.

Treatment plans: Outline the development and implementation of treatment plans.

Patient education: Detail the extent of patient education and counseling services.

Referral services: Indicate whether the physician will refer patients to other healthcare providers.

Record keeping: Specify the physician’s responsibilities for maintaining patient records.

Client Responsibilities

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This section outlines the obligations of the client. It should include:

Providing necessary information: The client must provide the physician with accurate and complete medical history, current medications, and any other relevant information.

Following instructions: The client must adhere to the physician’s instructions and treatment plan.

Payment obligations: The client is responsible for timely payment of all fees as outlined in the agreement.

Scheduling and cancellations: The client must comply with appointment schedules and provide adequate notice for cancellations.

Confidentiality: The client must maintain the confidentiality of any information shared with the physician.

Physician Responsibilities

This section outlines the obligations of the physician. It should include:

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Providing professional services: The physician must provide professional services with the appropriate standard of care.

Maintaining confidentiality: The physician must maintain the confidentiality of all patient information in accordance with applicable laws and regulations.

Obtaining informed consent: The physician must obtain informed consent from the client before any procedures or treatments.

Providing timely communication: The physician must communicate effectively with the client regarding their care.

Maintaining professional boundaries: The physician must maintain professional boundaries and avoid any conflicts of interest.

Fees and Payment

This section should clearly outline the fees for the physician’s services. It should include:

Fee structure: Specify the fee structure, such as hourly rates, per-visit fees, or package rates.

Payment terms: Indicate the payment terms, such as payment in full at the time of service, payment within a specific timeframe, or installment plans.

Late payment fees: Specify any late payment fees that may apply.

Methods of payment: Indicate the accepted methods of payment, such as cash, check, credit card, or electronic funds transfer.

Term and Termination

This section should outline the duration of the agreement and the conditions under which the agreement may be terminated. It should include:

Term of agreement: Specify the duration of the agreement, such as a specific term or an indefinite term.

Termination for convenience: Outline the conditions under which either party may terminate the agreement for convenience.

Termination for cause: Outline the conditions under which either party may terminate the agreement for cause, such as breach of contract or material breach.

Notice of termination: Specify the required notice period for termination of the agreement.

Confidentiality and Data Security

This section should address the confidentiality obligations of both parties and the security measures in place to protect patient data. It should include:

Confidentiality obligations: Both parties agree to maintain the confidentiality of all information exchanged during the course of the agreement.

Data security measures: The physician will implement appropriate security measures to protect patient data from unauthorized access, use, disclosure, disruption, modification, or destruction.

Data breaches: The physician will notify the client promptly in the event of a data breach.

Insurance and Indemnification

This section should address insurance coverage and indemnification obligations. It should include:

Professional liability insurance: The physician agrees to maintain professional liability insurance with adequate coverage.

Indemnification: Each party agrees to indemnify and hold harmless the other party from any claims, losses, or damages arising from the other party’s negligence or breach of the agreement.

Governing Law and Dispute Resolution

This section should specify the governing law and the method for resolving disputes. It should include:

Governing law: Specify the law that will govern the agreement.

Dispute resolution: Specify the method for resolving disputes, such as mediation or arbitration.

Entire Agreement

This section should state that the agreement constitutes the entire agreement between the parties and supersedes all prior or contemporaneous communications, representations, or agreements, whether oral or written.

Severability

This section should state that if any provision of the agreement is held to be invalid or unenforceable, such provision shall be struck and the remaining provisions shall remain in full force and effect.

Waiver

This section should state that the failure of either party to insist upon strict performance of any provision of the agreement shall not be construed as a waiver of any subsequent breach of such provision or of any other provision of the agreement.

Amendments

This section should state that any amendments to the agreement must be made in writing and signed by both parties.

Signatures

This section should include spaces for the physician and the client to sign and date the agreement.

Design Considerations

To convey professionalism and trust, consider the following design elements:

Professional font: Use a clean and professional font such as Arial, Times New Roman, or Calibri.

Clear and concise language: Use clear and concise language that is easy to understand.

Professional layout: Use a professional layout with clear headings, subheadings, and spacing.

White space: Use white space effectively to improve readability and create a clean and uncluttered appearance.

Professional letterhead: If applicable, use professional letterhead for the physician’s practice.

By carefully drafting and incorporating these elements, you can create a professional and effective Physician Professional Services Agreement that protects the interests of both parties.

This guide provides a general framework for a Physician Professional Services Agreement. It is important to consult with an attorney to ensure that the agreement complies with all applicable laws and regulations and meets the specific needs of your practice.