Letter of Intent Sample for Midwife

LETTER OF INTENT: MIDWIFERY CLINICAL SERVICES

Document Control

• Effective Date: [Date]
• Version: 1.0
• Jurisdiction: [State/Province]
• Scope: Professional Midwifery Services / Independent Contractor Agreement Preliminaries

1. LEGAL DISCLAIMER

This document constitutes a non-binding expression of interest regarding the intent to enter into a formal service agreement, except for provisions concerning Confidentiality, Governing Law, and Exclusivity, which shall be legally binding upon execution. This document does not constitute an employment contract or a definitive service agreement. All parties are advised to seek independent legal counsel before execution.

2. PARTIES

• Provider: [Full Legal Name of Midwife], holding professional license number [License Number] issued by [Issuing Board], having a principal place of practice at [Address].
• Clinic/Facility: [Company/Practice Name], a [Legal Entity Type, e.g., LLC] organized under the laws of [State], located at [Address].

3. OPERATIVE TERMS

I. SCOPE OF SERVICES The Provider intends to offer clinical midwifery services including, but not limited to, prenatal, intrapartum, and postpartum care, subject to the clinical protocols and standard operating procedures (SOPs) of the Facility.

II. COMPENSATION & BILLING The parties intend to structure remuneration as:

• Fee-for-service model at [Rate] per encounter.
• Retainer/Salary model at [Amount] per [Period].
• Revenue split of [Percentage] of net collections.

III. MALPRACTICE & INSURANCE The Provider shall maintain professional liability insurance in the minimum amount of [Dollar Amount] per occurrence and [Dollar Amount] aggregate, naming the Facility as an "Additionally Insured" party if required by the final agreement.

IV. TERM & TERMINATION This LOI shall remain in effect until [Date] (the "Exclusivity Period"), by which time the parties intend to execute a definitive Professional Services Agreement (PSA). Either party may terminate discussions by providing [Number] days’ written notice.

V. CONFIDENTIALITY During the term of this LOI, both parties agree to protect and maintain the confidentiality of all trade secrets, patient data, and proprietary clinical workflows disclosed during negotiations.

VI. GOVERNING LAW This document shall be governed by and construed in accordance with the laws of the State of [State].

4. SIGNATURES & ACKNOWLEDGMENT

IN WITNESS WHEREOF, the parties have executed this Letter of Intent as of the Effective Date.

For the Provider:

Signature: [Full Legal Name]
Date: [Date]

For the Facility:

Signature: [Authorized Representative Name]
Title: [Title]
Date: [Date]

5. EXECUTION GUIDE

1. Due Diligence Verification: Prior to signing, the Facility must perform a primary source verification (PSV) of the Midwife’s credentials, including state board standing and NPDB (National Practitioner Data Bank) queries.
2. Definitive Agreement Transition: Use this LOI as a "Term Sheet" attachment for the final PSA. Ensure the final PSA incorporates the indemnity and hold-harmless clauses specific to obstetric clinical risk.
3. Regulatory Compliance: Ensure this LOI acknowledges compliance with HIPAA (Health Insurance Portability and Accountability Act) and state-specific anti-kickback statutes regarding medical referrals.
4. Formal Execution: Ensure two original copies are signed; one must be kept in the Facility’s Human Resources/Legal file and one in the Provider’s professional records.