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Sample Memorandum of Understanding


This sample Memorandum of Understanding (MOU) is an example of an MOU used by a local health department to create a mutual agreement about patient care with an area medical care provider. This template can be tailored to another jurisdiction by addressing the yellow highlighted areas. In addition, this document can be used as a template for other types of MOUs, such as those between the local health department and a community-based organization.

Primary Toolkit:

HIV/STI Toolkit

Keyword Area:

Health Promotion and Health Education


Institutional Author:

North Georgia Health District





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.