SAMPLE
CONTRACT #1
CONTRACT
This
agreement entered into on (DATE)____________________, by and
between the Transcriptionist, known as: _______________, whose
address is _______________________,
and
telephone number is ________________.
And
the Professional client __________________. Whose address is
_________________ and telephone number is ______________.
Whereas
Transcriptionist desires to contract with the Professional
client to perform said work and/or service, and,
Whereas
the parties desire to set forth their contractual and business arrangements,
Therefore,
this agreement constitutes the said contractual and business
arrangements, and the parities contract and agree as follows:
The
Transcriptionist agrees to perform, abide by and follow the
stipulations listed in the remainder of this contract.
EQUIPMENT
The
transcriptionist is responsible for providing all equipment and
supplies necessary for any work done, other than supplies given
by the professional client (i.e. stationery indigenous to the
professional client). These supplies provided by the
transcriptionist, but not limited to, office equipment (i.e.
typewriter, computer, transcription equipment, etc.) paper,
dictionaries and manuals, tools, etc. The transcriptionist is
also responsible for all repairs on her own equipment.
Any
supplies that are necessary from the professional client must be
requested well in advance by the transcriptionist and the
transcriptionist is responsible for keeping adequate supply on
hand at all times. This supply must be returned to the
professional client should this contract ever cease.
Any
equipment or supplies loaned by the Professional client to the
Transcriptionist must be returned to the Professional client at
the termination of this contract, or final payment of any
payment due will be withheld until said items are returned.
PRICING AND
PAYMENT
Each
professional client’s pricing is set separately, according to
the individual client. Pricing is by each piece and/or line as
set forth in the WORK
SCOPE.
Payment
for services rendered is on ____________________(weekly basis,
biweekly basis, etc.). (This may be determined by the
Professional Client’s present staff practice). If the
Transcriptionist does not turn in invoices by the dates
specified, the Professional client is not responsible to pay by
any set date and pay may be late.
Client estimates that a total of approximately
_____ (number) reports and/or letters involving approximately
_____ (number) minutes of dictation will be dictated for each day that his/her office sees patients. It is
understood that the submission of dictation from multiple days at one time may require a longer turnaround time and that the established rate of __________ cents per __________ will remain in effect.
The
Transcriptionist must give a separate billing for each
professional client to the Professional client. Each billing
must be typewritten or computer generated and include the name
of the client, the dates of the billing, the pages and specific
dates of work completed and, if applicable, a description of
each piece of work completed, and individual pricing, as well as
total. The Transcriptionist must be prepared to back up each
billing with copies of work completed should the Professional
client request any information regarding the services rendered.
Professional
client will pay for any work containing errors. Transcriptionist is responsible to redo all work containing errors
without charge to the professional client or agency. If the
professional client should request a redo of the transcription
with minor editing changes that were not the fault of the
Transcriptionist then the Transcriptionist will provide redo at
½ of the original cost. Fax charge remains the same for each
page faxed each time it is faxed.
Professional client is not
responsible to pay for redo work in the case of power outages or
faulty equipment. It is the responsibility of
Transcriptionist to keep equipment in working order and to
provide backup emergency services should a technical problem
occur.
COMMUNICATION WITH
PROFESSIONAL CLIENTS
Transcriptionist
may not communicate with Professional client directly regarding
billing or pricing structure or anything other than a question
directly applying to the transcription or work procedures, such
as terminology, spelling, etc. unless it is the policy of the
professional client to do so. When communicating with the
Professional client on the above matters, transcriptionist must
identify herself as being the Proprietor of
_________________________.
WORK SCOPE
The
Transcriptionist is responsible for keeping a complete Work
Scope on each client. This Work Scope is to be given to the
Professional Client upon termination originated either by the
Transcriptionist or the Professional Client. The Work Scope must
be typewritten or computer generated, include the Professional
client’s name, address, telephone number, names of contact
personnel, list of specific terminology used by that
professional client, and any specialized instructions for that
professional client.
The
Transcriptionist is responsible for keeping one month of work
for each client on file for reference for billing purposes,
termination or request of the client for any particular piece of
work. The transcriptionist will also save the work on floppy
disc and on request will supply this to the professional client.
The
Transcriptionist is responsible to make specific arrangements
with the management of the Professional client for the delivery
of the workload.
The
Transcriptionist is responsible for providing services for the
assigned client at all times during the duration of this
contract. The Transcriptionist is responsible for notification
of any time needed for illness or vacation when this will
greatly affect the operation of the Professional client’s
work. There is no back up coverage with this contract.
The
Professional client expects loyalty, enthusiasm and total
support verbally, in action and in deed from the
Transcriptionist at all times.
SPECIAL
CONSIDERATIONS:
_____________________ _______________________________________________
MISCELLANEOUS
The
logo, name, promotional material, and advertising associated
with the Professional client are exclusively the property of the
Professional client. Unauthorized usage of any stationery or
materials or authorized representation of the Professional
client is strictly prohibited. The Transcriptionist cannot use
any name similar to or representing in any way, shape or form
the name, advertising methods and appearances or practices of
the Professional client.
TERMINATION OF
THIS CONTRACT
The
Transcriptionist must give no less that a 7-day notice to the
Professional client in writing for termination of this contract.
Anything less than a 7 day notice will result in 50% penalty fee
payable to the Professional Client and subtracted from the final
payment due to the Transcriptionist.
Before
the termination is effective, Transcriptionist must return all
supplies and/or equipment belonging to or loaned or borrowed
from the Professional Client. The Transcriptionist is also
responsible for supplying the Professional client with a copy of
all complete and detailed work scope as specified previously in
this contract. Failure to comply with any portion of this
termination stipulation or any portion of this termination
contract may result in withholding of final payment.
Violation
of any part of this contract can result in immediate termination
by the Professional client without notice. All termination terms
other than the 7-day notice would then be applicable for the
Transcriptionist and final check would be held until terms are
complied with.
Professional
Client reserves the right to remove from the Transcriptionist
(in the case of a multiple practice) without any notice.
Transcriptionist also agrees that Professional clients can be
dropped at any time due to termination from the client.
The
Transcriptionist hereby agrees to abide by all of the terms and
stipulations set forth in pages one through 5 of this contract
and understand each item fully, as signified by signing below.
The
contract will be in effect from date of the agreement and
continue for 6 months at which time a review will be made.
TRANSCRIPTIONIST
DATE__________________
S.S. NUMBER OF
TRANSCRIPTIONIST:___________________
PROFESSIONAL
CLIENT:
DATE_______________
EXHIBIT A – SERVICES FEE SCHEDULE
Professional
client will compensate
Transcriptionist $.__ per line defined as __ keystroke or characters for office
or hospital reports transcribed plus any additional transmittal
(fax) fees required to transmit the reports.
SPECIAL CHARGES
ARE:
AUTO EXPENSE FOR
DELIVERY:______________________
LOST
REPORTS: ½ the original cost.
STAT WORK: STAT
work is defined as anything requested in 12 hours or less: $.__
per line
TURNAROUND TIME
shall be 24 hours unless special arrangements are made.
FAXED REPORTS:
____________________________
COPIES: $.__ per
copy.
SPECIAL
DELIVERY:
$10.00 for the delivery (negotiable).
ANY PERSONAL
TYPING, such as curriculum vitae form, medical manuscripts
negotiable.
EXHIBIT B- ERRORS AND OMISSIONS:
I DO NOT
CARRY
ERRORS AND OMISSIONS INSURANCE.
THAT I DO NOT ENDORSE COMPUTER-AUTHENTICATED OR
ARTIFICIAL SIGNATURES GENERATED BY MEANS OTHER THAN ACTUAL
DICTATING PHYSICIAN’S SIGNATURES. THEREFORE, THE DOCTORS
SHOULD PROOFREAD THE TRANSCRIPTION FOR DOCUMENT CONTENT,
ACCURACY AND QUALITY CONTROL. THIS MEANS THAT THEY WILL ACCEPT
THE LIABILITY OF THE TRANSCRIPTION AND I WILL NOT PURCHASE
ERRORS AND OMISSIONS LIABILITY INSURANCE.
EXHIBIT C - NONDISCLOSURE AGREEMENT
By signing this
Nondisclosure Agreement, I indicate my understanding that:
Patients,
physicians and other health care providers furnish confidential
information to obtain or carry out medical services, and medical
service information and records are confidential.
Patients depend on
the providers of medical services to keep patient information
confidential. The provider’s reputation depends on this
confidentiality.
If medical
information has been used or disclosed inappropriately, patients
or providers who have suffered loss or injury may seek legal
action to recover damages from the person who used or disclosed
the information. Specific violations of patient confidentiality
resulting in economic loss or personal injury to a patient may
be punishable by law.
Any breach of
confidentiality will be considered serious and subject to
investigation and possible discipline, including immediate
termination of services. Therefore as a Transcriptionist
contract service provider, I agree that I will not at any time:
Disclose services given or information about patients.
Allow anyone else
to examine or copy any records or documents having to do with
patients, physicians, or other health care providers and
services.
"PHYSICIAN IS RESPONSIBLE FOR REVIEW OF ALL TRANSCRIBED DOCUMENTS BEFORE
SIGNING."
Independent
Contractor:
Date:_______________
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