This form is a Finder's Fee Agreement. The offerer and the finder agree to certain terms in furtherance of the mutual purpose of solciting customers and marketing the enterprise operated by the offeror. The document provides that the finder is authorized to represent the offerer in locating, soliciting, and selling to potential customers of the offeror.
Referral Fee Agreement Template For Doctor
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How to fill out Finders Fee Agreement?
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Explain the purpose of the referral. Contain enough information so that the other healthcare provider can provide appropriate care to the patient. Not include sensitive patient health information that is not relevant to the referral. Include a list of known allergies, adverse drug reactions, and current medicines.
How does this Medical Referral Form template work? Step 1: Download the referral form template. ... Step 2: Gather patient information. ... Step 3: Fill out insurance details. ... Step 4: Provide referring physician information. ... Step 5: Describe the reason for the referral. ... Step 6: Indicate additional tests or procedures.
The agreement should specify which products or services are eligible for referrals, how long the agreement lasts, and how it can be terminated or renewed. It should also explain how the referrer should identify, contact, and qualify potential customers, and how they should submit the referrals to you.
Yes, referral fees are legal, but only within certain industries. Most other industries also don't pose any requirements in order for a company to implement referral fees. However, since referral fees are not legal for all industries, you'll need to do some research to make sure you don't set up an illicit system.
Payment by or to a physician or health care institution solely for referral of a patient is fee splitting and is unethical. Physicians may not accept: Any payment of any kind, from any source for referring a patient other than distributions of a health care organization's revenues as permitted by law.