Locum Agreement

Between me, ____________________________________
locum tenens

and you, __________________________________________
Medical Practice

  1. Term:
    I will work as a locum tenens in your Medical Practice from ____________________ to __________________.

  2. Responsibilities:
    a) I will see patients in the office(s) of your Medical Practice during the hours listed below:

    Monday: __________________________
    Tuesday: _________________________
    Wednesday: _______________________
    Thursday: ________________________
    Friday: __________________________
    Saturday: ________________________
    Sunday: __________________________

    b) I will maintain locum hospital privileges and do regular rounds to care for inpatients of your Medical Practice at the following hospital(s): _______________________.

    c) My on-call and/or emergency room responsibilities will be ___________________________________________________________________ ___________________________________________________________________.

    d) I will see your patients at home or in local nursing homes when appropriate or as otherwise stated as follows: ___________________________________________________________________.

    e) I am not expected to provide obstetrical care so you will arrange appropriate coverage for this.

    f) I will review mail and test results and arrange appropriate follow-up for your patients.

    g) I will maintain licensure with the College of Physicians and Surgeons of B.C., CMPA coverage, and deliver reasonable and ethical care to all your patients.

  3. Payment:
    a) I will record on a day sheet the fee codes or fees charged privately (my billings) and diagnostic codes for all services I render on behalf of the Medical Practice. Fees charged by myself will be in accordance with MSP regulations and your usual Medical Practice policies. As a courtesy to your Medical Practice, I will avoid billing restricted MSP services such as counselling and complete physical exams unless clearly indicated or requested by the patient.

    b) Your Medical Practice will submit all my billings to MSP, WCB, other third parties, and/or the patients directly on my behalf. By signing the MSP transfer of payment release and this Agreement, I cause all my billings to be paid directly to your Medical Practice.

    c) Your Medical Practice will pay me ____% of all my billings for services performed during the office hours listed above. Outside these hours, your Medical Practice will pay me ____% of all my billings for services such as nursing home visits, hospital visits, home visits, emergency room shifts and emergency on-call stipends.

    d) If I am expected to do a walk-in clinic or treatment center shift as part of the agreed-upon coverage for your Medical Practice, your Medical Practice is responsible for any difference in payment if less than the terms in paragraph c) above.

    e) Your Medical Practice will pay me whether or not full payment is received by your Medical Practice for all my billings.

    f) Your Medical Practice will pay me a minimum of $_____________ for the term.

    g) Your Medical Practice will make payment in full to myself within two weeks of the end of the Term.

    h) Payments will be mailed to _____________________________________.

  4. Special Considerations:
    The following are special considerations and agreements particular to this locum arrangement: ______________________________________________________________________ ______________________________________________________________________

Date:______________________ Date:______________________


signed, locum tenens signed, on behalf of the Medical Practice