Forms to Manage a Technology Platform for Physicians, Etc.

When MSOs manage a clinical practice remotely or digitally (say as a telemedicine company), the MSO can benefit from clear agreements that help document the MSO’s management role, obligations, and fees. This set includes a questionnaire and explanatory report, an Agreement to manage a technology platform’s services, a sample spreadsheet to figure out profits and revenues, two sets of patient authorizations and another explanatory report, and a consent for telehealth.

What’s Included:

  • MSO Questionnaire
  • MSO Explanatory Report
  • MSO Spreadsheet
  • Platform Services & Licensing Agreement
  • MSO Patient Authorization for Disclosure of PHI
  • MSO Patient Authorization for Marketing
  • MSO Authorizations Explanatory Report
  • MSO Telehealth Consent

Need Help?

Do I need a special software to download or view the forms?

You will need Microsoft Word (97 or higher) to download and use the documents.

Can I use the forms more than once?

You can use the form for yourself. You may not transfer the form to any other third party for their use.

How do i download my form?

You can download your form(s) immediately after your purchase has been processed.

$ 525

Disclaimer: All content in this document has been prepared for informational purposes only and is not legal advice. Transmission of this information is not intended to create, and receipt does not constitute, an attorney-client relationship. You should not act upon this information without seeking professional counsel. This form provides sample language but provides no warranty, guarantee or assurance of freedom from enforcement action or scrutiny. See full Disclaimer.