Telemedicine Services Agreement

Telemedicine Services Agreement
State
Date of Effectivity
MonthDayYear
Date
Name of Service Provider
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Name of Client
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Purpose of Agreement
The purpose of this Agreement is to utilize the technology that enables telemedicine in order to provide patients living in the serviced areas to get proper medical care by specialists or specialization of Service Provider without the inconvenience and expense, both financial and time, to travel to the Client's address or location.
Terms of Agreement
Provider's Responsibility
Provider shall ensure that only licensed personnel shall provide medical services to the Client.
The provider shall have complete authority, management, and control over including, but not limited to, clinical diagnosis, procedure, treatment required or any other professional healthcare services necessary in connection with the provision of the telemedicine services in accordance with laws.
Client's Responsibility
The client shall not control, direct, interfere, nor supervise Provider in connection with the provision of medical services.
Client, when engaging or being utilized by Provider, shall ensure that only properly licensed medical healthcare professionals shall be employed and utilized in conducting a diagnosis, procedure, treatment, or other healthcare services necessary in connection with the telemedicine services Agreement.
Limitation Against Practice of Medicine
Notwithstanding any provision contained herein, this Agreement is not intended to
1. Supervise any non-licensed medical professional or individual in the practice of medicine.
2. Constitute the use of the medical license by anyone other than the licensed physician.
3. Perform any act that is contrary to state and federal laws.
Provider shall remain entirely independent of Client as to
1. Diagnosis and treatment of patients,
2. Prescription, order, or administration of any drug or medicine, and
3. All other medical, professional and ethical affairs of Provider.
Confidential Information
Any proprietary information such as, but not limited to relating to business operations, services, technology, software, among others, that the Service Provider may acquire from the Client through performance and within the effectivity of this Agreement which is not considered public knowledge shall be recognized as Confidential Information. Service Provider shall not in any way disclose the Confidential Information without the prior written consent of the Client. In case of uncertainty whether such information is considered confidential, it shall always be presumed confidential for the benefit and protection of the Parties.
Provider Name (Representative)
PrefixFirst NameLast Name
Signature of Provider (Representative)
Clear
Date Signed
MonthDayYear
Date
Client Name (Representative)
PrefixFirst NameLast Name
Signature of Client (Representative)
Clear
Date Signed
MonthDayYear
Date
Should be Empty:

Telemedicine Services Agreement

Purpose of Agreement

Terms of Agreement