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Appendix 4: Independent
Contractor Agreement
SAMPLE INDEPENDENT CONTRACTOR AGREEMENT
(All parties and names are intended to be fictitious.)
This Agreement is made and entered into as of this 20th day of February, 2009,
by and between Jones Clinic (“Clinic”), a for-profit professional limited liability
corporation incorporated under the laws of the state of Colorado, and John Smith,
DO (hereinafter the “Physician”) of Denver, Colorado, and is effective this 20th
day of February, 2009 (the “Effective Date”).
RECITALS
WHEREAS, Clinic desires to engage Physician to be readily available to perform
medical services for patients at the Medical Center, and Physician desires to obli-
gate himself to be available to perform such services, all on the terms and condi-
tions specified in this Agreement; and
WHEREAS, Physician is licensed to practice medicine in the state of Colorado and
is qualified to perform the services required by this Agreement.
NOW, THEREFORE, in consideration of the mutual covenants herein contained,
the parties hereto agree as follows:
1. Services to be Provided by Physician
Physician agrees to provide services to patients at the Medical Center including
(but not limited to) the following:
(a) Physician shall be on duty at the Center during business hours, Monday
through Friday, except for vacations, illness, and attendance at seminars and
meetings, and except as modified in an on-duty schedule mutually agreed
to by Physician and the Medical Director of Clinic.
(b) Physician shall make his medical services available to all patients who come
to the Medical Center in need of and seeking immediate physician ser-
vices during the hours he is scheduled to be on duty at the Medical Center.
Physician shall, when appropriate in his medical judgment, seek appropri-
ate consultations and refer patients for additional medical care to specialists
who are members of the Consulting Medical Staff of the Center. (Author’s
note: This may or may not be legal in light of Stark II and antikickback regu-
lations, depending upon the circumstances of the contract.)

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