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LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
THIS LOCUMSMART GENERAL LOCUM TENENS AGREEMENT (“the Agreement”) is made and
entered into by and between
(“Hospital”) and
(“Contractor”).
In consideration of the mutual promises set forth below and other good and valuable consideration, the
receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1.
Obligations of Contractor.
(a)
Contractor shall make available to Hospital locum tenens services, as defined under
applicable Medicare regulations and processes (including, but not limited to provisions under the
Medicare Claims Processing Manual §30.2.11), for providers (the “Providers”) who are qualified by
education, training, and experience to perform the clinical services as requested by Hospital (the
“Services”) in accordance with state and federal law. Contractor shall be responsible for verifying the
credentials of such Providers before they are to render services under the Agreement. Contractor shall
use its best efforts to furnish Hospital with the Providers for such periods of time, and under such terms,
as are mutually agreed to by the parties pursuant to the Confirmation Agreement which will be created
and stored in the locumsmart.net portal (“Request Procedures”).
(b)
Contractor shall expressly and affirmatively advise Providers that they are required to
render the Services in accordance with applicable law and current standards in the community.
Contractor hereby represents to the best of its knowledge that all Providers are qualified to perform their
duties under the Agreement. Contractor hereby represents and warrants that all Providers have all
licenses and certifications necessary to provide the Services, including, if applicable, any certifications
necessary for participation in government payor programs. In the event any Provider ceases to have all
necessary licenses and certifications, or is otherwise unable or unqualified to render the services required
by the Agreement, Contractor shall immediately remove that Provider and use best efforts to promptly
provide a qualified replacement.
(c)
Contractor shall obtain and maintain the documentation and verification records (the
“Background Information”) on each Provider as set forth on Addendum 1. Contractor shall supply
Hospital with the Background Information in accordance with the Request Procedures. In the event
Contractor fails to provide such documents, such failure does not waive the Contractor’s obligation to
ensure compliance with obtaining such Background Information. Contractor shall require each Provider
to sign a consent form for the release of Background Information to Hospital as well as any additional
applications that may be required for the position in which the Provider will perform services.
(d)
Contractor acknowledges and agrees to inform the Providers that they may be
required by Hospital to undergo substance abuse tests in the following circumstances: after an injury
occurring at the Hospital or while providing Services hereunder; when a medication handling discrepancy
occurs or when medication may have been stolen or improperly used at the Hospital involving the area
where such Provider provides Services hereunder; and when the Hospital believes it has reasonable
cause or suspicion that Provider is under the influence of alcohol, drugs, or other controlled substances
and Hospital will immediately contact Contractor in the event of such suspicion. Contractor agrees that, in
the event that a Provider will not consent to such testing, Hospital may request that such Provider be no
longer permitted to perform Services hereunder and Contractor will use best efforts to promptly replace
such Provider as requested by Hospital.
(e)
Upon notification by Hospital that any Provider is not qualified or competent, or is
otherwise unacceptable to perform the work for which the Provider is needed, Contractor shall
immediately remove that Provider and use best efforts to promptly present a qualified replacement.
Hospital shall provide Contractor with written notice as to the reason Hospital is requesting replacement
of such Provider, and shall cooperate with Contractor in providing necessary risk management
information, if applicable.
(f)
Contractor shall expressly and affirmatively advise Providers they are required to
keep and maintain appropriate records of the Services performed pursuant to the Agreement. Records of
all Services rendered at Hospital shall be the property of Hospital.
(g)
Contractor shall expressly and affirmatively advise Providers that they must comply
with OSHA Regulation concerning "Occupational Exposure to Bloodborne Pathogens."
(h)
With regard to each Provider presented by Contractor and accepted by Hospital,
Contractor agrees to arrange for those items set forth as Contractor’s Additional Obligations on
Addendum 2. Subject to Hospital’s preapproval of such expenses and costs, Hospital shall reimburse
Contractor for the cost of travel, housing and local transportation arrangements for Providers.
(i)
During the term of the Agreement, Contractor and Providers may have access to and
become acquainted with certain confidential information, consisting of business accounts, confidential
financial information, clinical protocols developed by Hospital, and other records of Hospital (some of
which may be developed in part by Contractor under the Agreement), which items are owned exclusively
by Hospital and used in the operation of its business (the “Confidential Information”). Contractor
acknowledges that the Confidential Information is secret, confidential and proprietary to Hospital. During
and after the term of the Agreement, Contractor shall not divulge any of the Confidential Information to
any other person or entity or use the Confidential Information for its own benefit or for the benefit of any
other person or entity, without the prior written consent of Hospital, which consent may be withheld in its
sole discretion. Contractor’s obligations under this Paragraph 1(i) shall survive the termination of the
Agreement. Contractor acknowledges and agrees that each Provider may be asked to execute the
Confidentiality Agreement attached hereto as Addendum 3 prior to being allowed to perform Services at
Hospital and that the unwillingness of a Provider to execute such Confidentiality Agreement shall make
the Provider unqualified to perform Services at Hospital. Notwithstanding anything contained in this
section or Addendum 3 to the contrary, for risk management and incident reporting, Providers can share
patient information with third party insurance carriers for purposes of performing duties under this
Agreement so long as such disclosures are in accordance with the Health Insurance Portability and
Accountability Act of 1996.
(j)
Contractor shall expressly and affirmatively advise Providers they must comply with all
applicable policies, rules and procedures of Hospital.
(k)
Contractor agrees not to discriminate on the basis of race, sex, religion, handicap, or
any other unlawful basis in the recruiting of Providers. Contractor agrees to notify Hospital as to any
reasonable accommodation required by any Provider it presents to Hospital.
(l)
Contractor agrees to maintain records relative to services performed under the
Agreement in sufficient detail to provide for verification by Medicare or other payers as required. To the
extent applicable, Contractor agrees to comply with the access to books, documents and records of
subcontractors provisions of §952 of the Omnibus Reconciliation Act of 1980 P.L 96‑ 499), and 42
C.F.R., Part 420, Subpart (D), §§420.300 et seq. In accordance with these provisions, Contractor will,
upon proper written request made in conformance with 42 C.F.R. §420.304, allow the Comptroller
General of the United States, the Secretary of Health and Human Services, and their duly authorized
representatives access to the Agreement and to Contractor’s books, documents and records (as defined
in 42 C.F.R. §420.301) necessary to certify the nature and extent of costs of Medicare reimbursable
services provided under the Agreement. Such access will be allowed, upon request, until the expiration of
four (4) years after Medicare reimbursable services are furnished pursuant to the Agreement. To the
extent that this provision varies from any provision required by any regulation issued under authority of
section 952 of P.L 96‑ 499, the provisions of said Regulation, 42 C.F.R., Part 420 as amended, shall be
deemed by the parties to supersede this provision and be made part of the Agreement by reference.
(m)
Contractor acknowledges that Hospital has in place a Code of Conduct which
focuses on maintaining high ethical standards and compliance with the law. Contractor agrees to
cooperate with the requirements of the Code of Conduct, including, if requested, completing a conflict of
interest disclosure statement.
(n)
Each patient receiving services from a Provider presented by Contractor and
accepted by Hospital under the Agreement shall be billed only by Hospital. Fees due from patients as a
result of services furnished by Providers hereunder belong to Hospital. Contractor agrees to direct
Providers to promptly execute such documents as are reasonably required to assign billing rights to
Hospital.
2.
Obligations of Hospital.
(a)
Except as otherwise provided herein, and provided that Provider has no adverse
Background Information as determined at Hospital’s sole discretion, Hospital agrees to accept Providers
presented by Contractor to fulfill its staffing needs for the Services. Hospital shall be solely responsible for
the operation of Hospital's medical services, including selection of medical providers presented by
Contractor.
(b)
Hospital shall provide each Provider with orientation upon arrival at Hospital, which
will be considered as part of paid time.
(c)
Hospital agrees to follow the Request Procedures, and provide Contractor with as
timely and accurate communication as possible when requesting locum tenens coverage. Hospital
understands and agrees that locum tenens providers are independent contractors who are free to accept
any locum tenens assignment, through any other contractor or hospital, up until the time that a
Confirmation Agreement is accepted by both Hospital and Contractor. Since any delay in communication
on the part of Hospital may result in a loss of revenue for the Contractor or Provider, or in the Hospital
losing the opportunity to contract with the Provider in question, Hospital agrees to make its best efforts to
respond to all presentations of Providers made by Contractor within 48 hours of receipt.
(d)
Hospital agrees to cooperate with Contractor’s reasonable risk management and
quality assurance activities. Should Hospital become aware of an incident which may give rise to a claim
under Contractor’s professional liability policy of insurance, Hospital agrees to notify Contractor of the
nature of the claim and report all necessary information related to the claim.
(d)
Hospital agrees that should Hospital, or any organization affiliated with Hospital, offer
Work (as defined below) to any Provider presented to Hospital by Contractor for a period of twenty-four
(24) months after the first date of presentation to Hospital or, if Provider has furnished services for
Hospital hereunder, for a period of twenty-four (24) months after the last day of Provider’s most recent
assignment Confirmation Agreement with Hospital under the Agreement, and said offer is accepted, then
Hospital shall pay to Contractor as consideration for the presentation a reassignment fee in the amount
as listed on Addendum 4 (“Reassignment Fee”) per Provider so hired or engaged, regardless of whether
or not that Provider actually performed work for Hospital through Contractor. This section shall survive
termination of the Agreement.
(e)
If a Provider accepts Work, the Reassignment Fee must be paid in full prior to the first
day the Provider performs services in the new position. Fees shall be assessed for services provided up
to the date the Reassignment Fee is paid. Once the Reassignment Fee is paid for any Provider under the
Agreement, Contractor shall not assess further fees for that Provider and there shall be no further
obligation as between Contractor and Hospital with respect to that Provider except for Hospital’s
obligation to reimburse Contractor for outstanding invoices due to travel, housing costs and local
transportation costs, if any, or any other outstanding invoices arising from services provided under the
Agreement prior to the date of full payment of the Reassignment Fee.
(f)
Hospital agrees to inform Contractor in writing within three (3) business days of the
presentation if any Provider presented by Contractor is already known to Hospital through means other
than Contractor. For any Providers about whom Contractor is so informed, Hospital will not have to pay a
Reassignment Fee to Contractor upon said Providers' acceptance of Work.
(g)
For purposes of the Agreement, “Work” shall mean a written offer to work on a part or
full time basis, temporary or permanent, directly as an employee or independent contractor of Hospital.
(h)
Hospital shall keep confidential all Confidential Information of Contractor, and shall not
use or disclose such Confidential Information either during or at any time after the term of this Agreement,
without Contractor’s express written consent, unless required to do so by law, court order or subpoena in
which case the other party shall not disclose such information until it has provided advance notice to the
indemnifying party such that the indemnifying party may timely act to protect such disclosure. For
purposes of this provision, “Confidential Information” means non-public information about either party and
its employees that is disclosed or becomes known to the other party as a consequence of or through its
activities under this Agreement, including, but not limited to, matters of a business nature, such as Locum
Tenens Independent Contractors and prospective Locum Tenens Independent Contractor’s names and
information, bill rates, compensation requests for placement, costs, profits, margins, markets, sales,
businesses, processes, information systems, and any other information of a similar nature. Hospital
agrees to use appropriate security measures to protect contractor’s employee, client and/or healthcare
provider personal information from unauthorized access, destruction, use, modification or disclosure in
accordance with all federal and state privacy laws.
3.
Term and Termination. The term of the Agreement shall begin on the first day that it has been
signed by both Parties. The Agreement may be terminated by either party:
(a)
without cause upon sixty (60) days written notice to the other party; or
(b)
upon breach of the terms and conditions of the Agreement by the other party after
giving thirty (30) days written notice to the other party; provided, however, that if the other party corrects
the breach before the expiration of the thirty (30) day period, the Agreement will not terminate.
4.
Request Procedures.
(a)
Both Hospital and Contractor agree to utilize the web-portal located at
www.locumsmart.net as the Request Procedures for all locum tenens assignments booked under this
Agreement, and to abide by LocumsMart’s Terms of Use and Privacy Policy.
(b)
Both Hospital and Contractor agree that the rules and terms governing each locum
tenens assignment under this Agreement shall be determined in two parts: 1) by the terms and conditions
contained in this Agreement and its Addendums, and 2) by the terms and conditions contained in each
assignment's electronic Confirmation Agreement. Hospitals and Contractors both agree to create,
electronically accept, and store Confirmation Agreements on LocumsMart for each assignment that takes
place under this Agreement. Both this Agreement and each individual assignment's Confirmation
Agreement will be stored on the locumsmart.net portal and will be accessible at any time by either
Hospital or Contractor. Unless the Agreement is modified by a written amendment duly executed by
authorized representatives of the parties, any subsequent requests for additional Providers during the
Term of the Agreement, or extensions thereof, shall also be governed by the terms and conditions of the
Agreement.
(c)
With regards to the Request Procedures to be followed by Hospital, a graphical
explanation is attached hereto as Addendum 5.
(d)
With regards to the Request Procedures to be followed by Contractor, a graphical
explanation is attached hereto as Addendum 6.
5.
Fees and Taxes.
(a)
For the services provided pursuant to the Agreement, Contractor shall be
compensated in accordance with the fees set forth in each assignment Confirmation Agreement created
as a part of the Request Procedures.
(b)
Unless otherwise agreed to by the parties in an assignment Confirmation Agreement,
invoices will be sent via mail weekly or bi-weekly to Hospital. Each party shall promptly notify the other
party in writing of any billing errors of which such party has knowledge. Contractor’s account
representative and Hospital’s representative shall work with all due haste to reconcile any account billing
discrepancies. Hospital shall pay Contractor for Services the undisputed sum of each invoice within 30
days of receipt of such invoice. In the event that the total invoice amount is not timely paid and is not in
dispute, in addition to its other remedies, Contractor may impose, and Hospital shall pay, a late payment
charge equal to one percent (1.5%) of the overdue amount each month. Hospital shall furnish Contractor
with documentation to support any disputed invoice. Hospital agrees to pay all expenses and costs,
including interest and attorneys’ fees, which may be incurred if collection efforts are necessary to enforce
this Agreement.
(c)
Contractor shall report and pay all of Contractor's applicable taxes associated with
services rendered pursuant to the Agreement. Contractor shall indemnify and defend Hospital in the
event any tax authority prosecutes Hospital because of Contractor's failure to submit reports or returns,
making necessary payments, or maintain required records provided Hospital promptly notifies Contractor
of such a claim and Contractor has the right to direct, with Hospital's consent and approval of decisions
affecting Hospital throughout the process, the defense of any such claim. The parties agree and
acknowledge that Hospital has the right, but not the obligation and not without first notifying Contractor of
its intentions, to pay any taxes assessed against Hospital by any tax authority for services rendered
pursuant to the Agreement, and such payment shall not affect Contractor’s obligation to indemnify
Hospital. Contractor’s obligations under this Paragraph 5(c) shall survive the termination of the
Agreement. Notwithstanding the forgoing, the Hospital acknowledges that Contractor’s Locum Tenens
Providers are not Contractor’s employees but are independent contractors. As the Locum tenens
Providers are not Contractor’s employees, contractor represents that it does not provide benefits
including but not limited to health insurance, purchase worker’s compensation insurance, provide
unemployment insurance, or make payments or deductions from, the Locum Tenens Providers’
compensation for state or federal government taxes.
6.
Scope of Relationships.
(a)
None of the provisions of the Agreement is intended to create nor shall be deemed or
construed to create any relationship between the parties hereto other than that of individual entities
contracting with each other solely for the purpose of effecting the provisions of the Agreement. Neither of
the parties hereto shall be construed to be the agent, employee, or representative of the other.
(b)
Providers presented by Contractor to Hospital are independent contractors of
Contractor and shall not be employees or agents of Hospital for any reason during their assignment with
Hospital. Notwithstanding anything contained in the Agreement to the contrary, each Provider referred
hereunder is an independent contractor of Contractor. Contractor shall be responsible for compensating
Providers directly. As independent contractors, Contractor does not pay employment taxes for Provider
or furnish Worker’s Compensation coverage. Contractor does not make clinical decisions for Providers
and does not otherwise direct or control the clinical services furnished by Providers. Contractor makes no
guarantee regarding any Provider and specifically disclaims the same.
(c)
The relationship between Hospital and Contractor is non-exclusive. Nothing
contained herein shall prevent Hospital from contracting with other companies to render the same or
similar services to those being provided by Contractor.
7.
Indemnity.
Contractor agrees to indemnify Hospital, its officers, directors, employees and agents from and against
liabilities, claims, suits, actions, causes of action and damages incurred by Hospital as a result of any
negligent act or omission of Contractor. Notwithstanding the foregoing, contractor’s obligation to
indemnify does not extend to any acts or omissions of Providers supplied pursuant to this agreement.
Hospital agrees to indemnify Contractor, its officers, directors, employees and agents from and
against any and all liabilities, claims and damages incurred directly as a result of any act or omission of
medical malpractice arising out of medical services provided by and under the direction and control of
Hospital, its agents and employees, up to $1 million per incident, inclusive of costs and fees. Hospital
shall not have any liability for payment of amounts to Contractor for professional liability in excess of the
amount stated in this provision.
The indemnification provisions described herein are contingent upon the indemnitee fully
complying with the following requirements: a) cooperating in the investigation, settlement or defense of
any suit, action, cause of action or claim and permitting indemnitor and indemnitor’s attorneys and
insurers to control and direct the defense of the same; b) promptly notifying the indemnitor of any
demand, notice, suit, summons, complaint or legal paper in connection with any suit, action, cause of
action or claim; c) promptly notifying any other insurer whose coverage is available to the indemnitee; d)
cooperating with indemnitor and indemnitor’s attorneys and insurers with respect to coordinating other
applicable insurance available to indemnitee; and e) providing written authorization to obtain records and
other information related to the suit, action, cause of action or claim.
8.
Miscellaneous.
(a)
Assignment. Neither party may assign its rights and/or obligations hereunder without
the prior written consent of the other party, except that Hospital shall be permitted to assign the
Agreement to any successor entity that acquires and operates the hospital.
(b)
Severability. If any part of the Agreement is contrary to, prohibited by, or deemed
invalid under applicable law or regulation, such provision shall be inapplicable and deemed omitted to the
extent so contrary, prohibited, or invalid, but the remainder thereof shall not be invalidated thereby and
shall be given full force and effect so far as possible.
(c)
Waiver. A waiver by either party of a breach or failure to perform shall not constitute
a waiver of any subsequent breach or failure. In order to be effective, any waiver must be in writing and
signed by a representative of the party waiving any right or requirement.
(d)
Notices. All notices, requests, consents and other communications required or
permitted under the Agreement shall be in writing and shall be either hand-delivered, sent by a nationallyknown overnight service, or mailed by US Mail return receipt requested, to:
If to Hospital:
If to Contractor: to the address indicated on the assignment Confirmation Agreement
or to such other address as either party may designate by notice complying with the terms of this
Section. Notice shall be considered effectuated upon hand-delivery or overnight delivery or three (3)
days after mailing as set forth above.
(e)
Entire Agreement. The Agreement constitutes the entire understanding between the
parties with respect to the subjects covered herein and supersedes any and all other agreements
between the parties, either oral or written.
(f)
Amendments. No amendments, modifications, or waivers of the Agreement or of any
of its provisions may be enforced unless in writing and executed by authorized representatives of both
parties.
(g)
Enforcement Cost. In the event that any legal action is brought for the enforcement of
the Agreement or because of an alleged dispute or breach, the prevailing party shall be awarded its cost
of suit and reasonable attorney's fees.
(h)
Approvals. Neither the Agreement nor any amendment or modification hereto shall
be effective or legally binding upon Hospital or Contractor unless and until it has been reviewed and
approved by authorized representatives of Hospital and Contractor. By executing this Agreement, or any
amendment thereto, the signatories of Hospital and Contractor represent and warrant that they are
authorized representatives of Hospital or Contractor.
(i)
Cancellation of Assignments. In the event that Hospital wishes to cancel an Assignment,
Hospital must provide to Contractor written notice of cancellation of the Assignment at least thirty (30)
days in advance of the date upon which the Provider is scheduled to provide the services (For the
purposes of this Agreement, canceling an Assignment on the LocumsMart portal shall be considered
written notice of cancellation). In the event that Hospital provides less than thirty (30) days notice of
cancellation, Hospital shall be responsible for payment of the total fee due for the period covered by the
Assignment up to a maximum of thirty (30) days and other actual fees and charges, only if such fees and
charges were preapproved by Hospital, that may result from cancellation of the Assignment, including but
not limited to lost rents, security deposits and airfare. In the event that the Assignment is scheduled less
than thirty (30) days in advance, and Hospital cancels, Hospital shall be responsible for payment of the
fee due for the period covered by the Assignment up to a maximum of thirty (30) calendar days and other
actual fees and charges, only if such fees and charges were preapproved by Hospital, that may result
from cancellation of the Assignment, including but not limited to lost rents, security deposits and airfare.
(j)
Not Under Investigation. Each party represents that it is not currently under investigation
or debarred by any state or federal governmental agency for Medicare or Medicaid fraud. Further, each
party represents to the best of its reasonable knowledge its currently excluded from participating in the
Medicare or Medicaid programs, and that no such proceeding is pending. In the event an investigation of
a party is initiated by any state or federal governmental agency, or it s discovered that the representations
contained herein are false, the non-breaching party reserves the right to immediately terminate this
Agreement. It is understood and agreed to by the parties that the ability to verify if any Staff are currently
debarred is dependent upon the accuracy of the information contained on the OIG list of excluded
persons and re representations of each individual Staff.
(k)
No Liability for Drafter of Agreement. The parties acknowledge that they have willfully
entered into the Agreement, and accepted its language as written. If there is a dispute about the language
of this Agreement, the fact that one party drafted the Agreement shall not be used in its interpretation.
IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement on the day and year set
forth below.
For HCO:
For ____________________________:
Signature: _______________________
Signature: _______________________
Printed Name: ____________________
Printed Name: ____________________
Title: ____________________________
Title: ___________________________
Date: ___________________________
Date: ___________________________
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
BACKGROUND INFORMATION
Addendum 1
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.
“Background Information” to be provided on each Provider:
1. 2 references and work history verification or C.V.
2. Copies of current certifications (BLS, ACLS, PALS, etc.)
3. Copies of current licenses
4. Employee eligibility verification
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
FEES AND ADDITIONAL OBLIGATIONS
Addendum 2
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.
CONTRACTOR’S ADDITIONAL OBLIGATIONS:
Contractor is obligated to arrange for the following:
(i)
Reasonable living accommodations;
(ii)
Reasonable round trip transportation to and from the Hospital (if applicable);
(iii)
Reasonable local transportation (including a pro rata allocation for automobile insurance);
(iv) General liability insurance with limits of $1 million per occurrence and $3 million
aggregate. It is expressly understood by both Hospital and Contractor that General liability does not
extend to Providers. Contractor shall provide professional liability insurance coverage for each Provider
while on assignment hereunder in the amount of $1 million per occurrence and $3 million aggregate,
regardless of when a claim is filed. Contractor shall ensure that Hospital is a certificate holder on all
insurance coverage required by the Agreement and will provide a certificate of insurance reflecting such
insured status of Hospital.
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
INDEPENDENT CONTRACTOR CONFIDENTIALITY AGREEMENT
Addendum 3
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.
I, _____________________, recognize and acknowledge that, in the performance of my services at
______________________________________ (the “Hospital”) as an independent contractor, as an
independent contractor of a staffing agency, or as a student, I will be working with and have access to
certain Confidential Information. Confidential Information includes, but is not limited to, information
disclosed to me or known by me as a result of my association with the Hospital and the services I provide
to the Hospital and information about the Hospital's operations and other matters (whether or not such
information constitutes a trade secret) that are of a confidential or proprietary nature, including and
related to, but not limited to, patient background information, medical records or other medical
information, diagnostic reports, Hospital organizational information, clinical information, computer data,
and financial information in whatever form such information may exist including any charts, records,
manuals, data, computer data, notes, drawings, graphs, analyses, and related materials.
I agree to keep all such Confidential Information in strict confidence and will not at any time, during or
after the performance of services for the Hospital, disclose or disseminate any Confidential Information
that I may be provided or have access to as a result of my association with the Hospital and the services
provided to it to any third party except in connection with and as necessary to the performance of my
services for the Hospital and with any further patient consent as may be required. Specifically, but without
limiting the foregoing, I agree not to disclose any Confidential Information to persons not authorized by
the Hospital, and I further agree that Confidential Information must not be disclosed to competitors,
suppliers, contractors, family members, or __________________________________. I also agree not to
reproduce, transmit, transcribe, or remove from the premises of the Hospital any Confidential Information
except in connection with and as necessary to the performance of my services for the Hospital.
Furthermore, I agree not to use any Confidential Information for my personal gain or for that of persons
not affiliated with the Hospital.
I understand and agree that I am obligated to maintain patient confidentiality at all times whether or not
such patient confidentiality involves Confidential Information. I understand that it is not permissible to
discuss patient-related Confidential Information in public places or with persons that have no reason to
know the patient’s medical care or treatment.
I understand and agree that any and all computer system access codes and passwords that are assigned
to me are confidential. I will not disclose any such codes or passwords to anyone other than as necessary
in connection with the services I provide to the Hospital. If I have reason to believe that the confidentiality
of such codes or passwords has been violated, I will contact the MIS Department of the Hospital
immediately. Upon termination of my independent contractor relationship, I understand that any and all
codes and passwords that have been assigned to me will be deleted from the appropriate system(s) and
that I will have no right or interest in any data related thereto. Notwithstanding the terms of this
Confidentiality Agreement, I understand and agree that I have no personal expectation of privacy with
respect to any Confidential Information.
I understand that any deviation from the requirements set forth in this Confidentiality Agreement could
result in legal liability and legal action against me. I further understand that any breach of this
Confidentiality Agreement, intentional or unintentional, may result in immediate termination of my
contractual relationship with the Hospital.
My signature below certifies that all of the above confidentiality requirements have been explained to me,
that I was afforded the opportunity to ask questions about such requirements, and that I agree to be
bound by the terms of this Confidentiality Agreement.
Signature: ________________________________
Date: __________________________________
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
REASSIGNMENT FEES FOR PERMANENT PLACEMENT OF LOCUM TENENS
Addendum 4
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.
Hospital agrees to pay a reassignment fee to Contractor for the reassignment of Providers who are hired
on a permanent basis by Hospital, according to the definition used in this Agreement. The amount of the
reassignment fee will be based on Provider’s specialty type:
I.
For all Mid-Level Providers so placed, with the specific exception of CRNAs,
Contractor shall be owed a $18,000 fee.
II.
For all CRNAs so placed, Contractor shall be owed an $20,000 fee.
III.
Contractor shall be owed a $22,000 fee for all providers so placed of the
following medical specialties: Internal Medicine, Family Medicine, Pediatrics, Psychiatry.
IV.
fee.
For all other medical specialties so placed, Contractor shall be owed a $25,000
The reassignment fee is due as to any Provider whose services or curriculum vitae were made available
to Hospital, or affiliate of Hospital, by Contractor under the Request Procedures of this Agreement. For
purposes of this Agreement, an affiliate of the Hospital includes, but is not limited to, an organization or
person that has any form of direct or indirect business relationship with Hospital, any entity comprised of
one or more owners of Hospital, or any successor to or assignee of Hospital.
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
HCO REQUEST PROCEDURES
Addendum 5
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.
LOCUMSMART GENERAL LOCUM TENENS AGREEMENT
VENDOR REQUEST PROCEDURES
Addendum 6
This Addendum is attached to and made a part of that certain LocumsMart General Locum Tenens
Agreement between the parties, dated the__ day of _____, 20__.