This is an independent contract agreement between a health care worker and a provider of health care services such as vaccinations, screenings and health education, and who uses the services of qualified independent healthcare professionals, including but not limited to registered nurses, licensed practical nurses, nurse assistants, medical assistants and phlebotomists to provide such services.
This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.
