Independent Contractor Agreement for Health Care - Free Download | Page 2
4.6, 3243 votes
Please vote for this template if it helps you.
proof of such insurance coverage by providing Purdue with the applicable certificate or
4. Representations of Provider
. Provider represents and warrants that, except as
previously disclosed in writing to Purdue, the following are true with respect to each
Provider (if applicable):
A. Provider’s license or certification in any state has never been suspended, revoked,
restricted, or deemed to be probationary;
B. Provider has never been reprimanded, sanctioned, or disciplined by any licensing
or accrediting board;
C. There has never been entered against Provider a final judgment in a professional
liability action and no action, based on an allegation of professional liability or
malpractice by the Provider has ever been settled by payment to the plaintiff;
D. Provider has never been denied membership or reappointment of membership on
the medical staff of any hospital, and no clinical privileges of the Provider have
ever been suspended, curtailed, or revoked; and
E. As of the date hereof, Provider has not been the subject of any report or disclosure
submitted to the National Practitioner Data Bank.
5. Contract Rate
. Provider shall be compensated for services performed under this
Agreement as follows: __________________________________________________.
Provider shall be paid only for work actually performed by Provider under the terms of
this Agreement, and Provider shall not be entitled to any additional compensation or
other benefits of any kind.
6. Billing. Provider shall invoice Purdue each month, which invoice shall be due and
payable 30 days from receipt.
Invoices should be sent to the following Purdue individual:
Purdue Contact Name: ___________________________________________
Departmental Area: ______________________________________________
7. Compliance with Laws
. Provider agrees to comply with all federal and state laws or
regulations applicable to the services to be provided under this Agreement. The parties
further agree that they will protect and secure the privacy and confidentiality of patient
information and will comply with the requirements contained in the attached Business
. Provider represents and warrants that Provider has never been sanctioned
by the Office of Inspector General (“OIG”) of the Department of Health and Human
Services, barred from federal or state procurement programs, or convicted of a criminal
offense with respect to health care reimbursement. Provider shall notify Purdue