PROFESSIONAL SERVICES AGREEMENT

For the services of _______________[insert physician/clinician name and/or department]

THIS AGREEMENT is dated as of ________, 20__ (the “Effective Date”) by and between [COMPANY] on behalf of [COMPANY] University (“collectively [COMPANY]”), a [STATE] nonprofit corporation with a principal office at [ADDRESS] and _______________ (the “Practice”)

[Note: if this is a clinical services agreement with a hospital other than [COMPANY], please replace Practice with Hospital. OGC will make other appropriate changes] with an office at

__________________ (collectively, [COMPANY] and the Practice are referred to herein as the “Parties” and each is a “Party”).

WHEREAS, the Practice is engaged in the provision of medical services to patients at

___________________[ Name of Hospital/Clinic] located at ___________________ which [is]/[are] located on Exhibit A. (“Facility”)

WHEREAS, the Practice desires to engage [COMPANY] to provide a ________[type of provider/specialty] who can assist Practice in providing professional services at Facility; and

WHEREAS, [COMPANY] desires to increase the access of patients to medical care by placing specialized physician(s) in community settings, and is willing to make one or more of its physician(s) available to the Practice in accordance with the terms set forth below;

NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, the Parties hereby agree as follows:

SCOPE OF THE AGREEMENT:

The Engagement. The Practice hereby engages [COMPANY] to make available to the Practice, on an independent contractor basis, the services of [COMPANY] physicians specializing in __________ (collectively, the “Physicians” and each is a “Physician) to provide the Services described in Exhibit B to patients of the Practice at the Facility listed on Exhibit A. [[COMPANY] shall cause the Physician(s) to devote a total of approximately/at least __ hours per month/week/year to the Services not to exceed __ hours per month/week/year.]

The Services. Subject to the requirements of Article 2 of this Agreement, the Physician(s) shall provide to or for the benefit of the patients of the Practice those clinical services (the “Services”) listed on Exhibit B.

RESPONSIBILITIES AND DUTIES OF THE PRACTICE: