ContractorContract

The Professional Services Contract

THIS AGREEMENT is entered into this DATE by and between PHYSICIAN based at _______
__________________________________________ hereinafter referred to as PHYSICIAN
and Anita Evangelista, Contract Nurse Practitioner, hereinafter referred to as "Consultant".

Consultant, pursuant to the provisions of this agreement, is retained by PHYSICIAN to
provide nurse practitioner services for PHYSICIAN. The specific services to be provided to
PHYSICIAN by the Consultant are:

See Collaborative Practice Agreement, attached.
And, in addition: ________________________________________
_____________________________________________________

     As full and complete payment for Consultant's services and for the discharge of all
Consultant's obligation hereunder, PHYSICIAN or Physician's Clinic Representative shall pay
Consultant according to the following schedule:

     FEES: A flat rate of $45 per hour for services performed according to specifications above.

     EXPENSES: Consultant will provide at its own all ordinary and personal items and
transportation as may be necessary or appropriate to the rendering of the services herein
contemplated. PHYSICIAN will not be responsible for payment or reimbursement of any fees
or expenses of Consultant, excepting for those fees and expense items specifically
authorized or otherwise set forth in this agreement and as specified in services / work.
PHYSICIAN will reimburse Consultant for all reasonable expenses incurred which are
incidental to the services performed hereunder and which have been agreed upon in advance
and in writing by PHYSICIAN and Consultant.

     PORTABLE EQUIPMENT: The Consultant will be expected to maintain its own primary
diagnostic medical equipment, including stethoscope, otoscope, and manual or electronic
blood pressure monitor, in good working order and use same for appropriate patient
examination and care.

     LABORATORY TESTING AND CLINIC USE: Pursuant to lawful and appropriate clinical
decision-making, use of CLIA testing and authorization to order appropriate clinical, imaging,
and other diagnostic testing, billable to patients, will be considered an ordinary and expected
portion of the Consultant's work.

     BILLING AND PAYMENT: Consultant will maintain an accurate record of time spent in
patient care on an appropriate time sheet, and provide this to the PHYSICIAN on the Friday of
each week wherein work was performed. Payment of fees and reimbursement for expenses
incurred (if any) will be made within 14 days after receipt of an invoice by PHYSICIAN.
Invoices which remain unpaid after 30 days will also pay interest at the rate of 1-1/2% per
month or portion of month overdue.
     All invoices must specify the invoice total and period covered. Expenses must be itemized
and substantiated by the attachment of receipts for all expense items.

     It is understood that Consultant is an independent professional contractor and that
Consultant will not in any event be construed as or hold themself to be employees of
PHYSICIAN. It is further agreed that Consultant, as an independent contractor, is not
restricted to working exclusively for PHYSICIAN during the term of the agreement.

     Consultant is responsible for Workers Compensation, Disability, Unemployment,
Automobile Insurance, and any other insurance required by the State of MISSOURI, including
malpractice insurance. Consultant is also responsible for payment of State and Federal
taxes, and any other applicable tax. Consultant is not eligible for any benefits PHYSICIAN may
provide for its employees.

     Consultant recognizes that all records and copies of records touching PHYSICIAN's
operations, investigations and business made or received by Consultant during the period of
this agreement are and will be the exclusive property of PHYSICIAN, and Consultant will keep
the same at all times in Consultant's custody and subject to Consultant's control, and will
surrender the same to PHYSICIAN immediately upon the request of PHYSICIAN, or upon
completion to agreed upon services. HIPAA and other Local, State, or Federal patient privacy
regulations will be enforced.

     This agreement is effective on the above date entered into and will terminate upon
agreement by both parties as attested by their signatures and termination date below.
PHYSICIAN or Consultant may terminate this agreement without cause upon written
notification to the other party at the address shown in this agreement. PHYSICIAN may
terminate this agreement immediately upon Consultant's refusal to, or inability to perform
under the agreement or Consultant's breach of this agreement. Consultant may terminate
this agreement immediately upon PHYSICIAN's inaccessibility for appropriate collaborative
consultation, or on PHYSICIAN's refusal to, or inability to perform under this agreement. On
termination of this agreement, PHYSICIAN's obligation to pay Consultant, except for services
already accrued or incurred, will forthwith cease and terminate.

     If mutually agreeable to PHYSICIAN and Consultant, this agreement may be extended.
Such extension will be documented by written amendment, duly signed and dated by both
parties.

     Neither party to this agreement may assign, sell or transfer any part thereof to any other
firm or entity without first obtaining the written permission of the other party hereto.

     This agreement has been negotiated, executed and delivered in the State of Missouri. The
parties hereto agree that all questions pertaining to the validity and interpretation of this
agreement will be determined in accordance with the laws of the State of Missouri
.
.....This agreement and referenced attachments constitute the entire contract of the parties
hereto and supersedes any prior agreement between the parties.
Dated ________, and executed at City____________, State __________________

By: PHYSICIAN ________________________________________
.
By: CONSULTANT______________________________________

______________________________.....________________________________
Signature..........................................................Signature

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By agreement this date_________________________ the contract herein is terminated.

Signature________________________________
                    Physician

Signature________________________________
                    Consultant