Basic Memorandum of Understanding Sample

Contract # _________
Memorandum of Understanding
Between
{insert name of clinic or health plan}
and
[SPONSOR]
I. Parties of the Memorandum
Parties to this Memorandum of Understanding (Memorandum) are:
A. [SPONSOR], the primary sponsor of the [name of collaborative]. Referred to as the
Collaborative from this point forward.
B. Clinic or health plan address, phone, fax, and e-mail address are as follows:
Manager for {INSERT
HEALH PLAN OR CLINIC}
is:
Manager for [SPONSOR] is:
Contractor Name
Address
City, State Zip Code
Phone: ( )
Fax: ( )
E-mail:
Name
[SPONSOR]
Address
City, State, ZIP
Phone: ( )
Fax: ( )
E-mail:
II. Purpose
The purpose of this memorandum is to specify the agreements of [SPONSOR], and the
{insert health plan or clinic} as participants in the Collaborative. The parties to this
memorandum agree to participate in this health care quality improvement project. The
goal of the project is to improve the quality of [chronic condition] care in a cost-effective
manner through partnerships and collaborations using proven, evidence-based practices.
In addition the health plan or clinic agrees to work to achieve improvements in
[mandatory measures listed here].
This memorandum also specifies the responsibilities of co-sponsors of and organizations
supporting the Collaborative:
[additional sponsor here]
1
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