Any activity in which a faculty or staff member provides clinical or medical directorship services outside of UCLA Health requires a clinical services agreement ("CSA").  A CSA may also be used when a non-UCLA physician or provider is contracted to provide clinical services at UCLA if a determination has been made that an employment agreement would either not be appropriate or applicable. 

The UCLA Health has adopted a CSA development and review process which requires the completion and submission of a Clinical Services Form ("CSA Form"). This form requires a password.  Please enter " csa11 " when requested.  

The Chief Administrative Officer of the requesting clinical department is responsible for completing and submitting the CSA Form to the Contracts Manager at the UCLA Managed Care Contracting Office to initiate the CSA review process.  Please note that, in certain circumstances, prior approval of the clinical department chair, division chief and/or President of the Faculty Practice Group may be required.

The UCLA Managed Care Contracting Office will coordinate the process of the CSA Form with the UCLA Health Office of Legal Affairs and other administrative offices, such as the UCLA Health Office of Risk Management and the UCLA Health Office of Compliance Services, as necessary.