CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS"

Transcription

1 CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS Dear Physician Member: Thank you for contacting the California Medical Association and thank you for your membership. In order to advocate on your behalf, it may be necessary for CMA staff to receive and review claims data and other documentation that may include Protected Health Information ("PHI"). As a "business associate" under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, CMA requests that physician members sign and return the attached CMA Business Associate Agreement ("Agreement"). This will ensure that CMA complies fully with federal and state privacy protection laws. This Agreement provides satisfactory assurances that CMA will appropriately safeguard all PHI it discloses, or receives from or on behalf of physician members. Although CMA has had a standing Business Associate Agreement with its members, changes in the law pursuant to the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) have increased the obligations of business associates, necessitating CMA to update the standing Agreement. To receive assistance from CMA, please: 1. Fill in physician name and name of practice in the space provided at the top of page 1of the Agreement; 2. After reviewing, sign and date the Agreement on page 5; 3. Keep original copy for your records; 4. Promptly return a copy of the executed Agreement to CMA by fax to (916) or by to Once we receive the signed CMA Business Associate Agreement, CMA will be pleased to assist you. California Medical Association Last Updated: September 1, 2010

2 CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS This HIPAA Business Associate Agreement is made by and between, ("Physician Practice") and California Medical Association, a California nonprofit trade association ("CMA") and is effective as of the earlier of the date on which CMA first performed Services (as defined below) for Physician Practice or the date on which CMA first received Protected Health Information from Physician Practice (as defined below) ("Effective Date"). This HIPAA Business Associate Agreement amends and incorporates by reference all existing agreements between Physician Practice and CMA. Recitals A. CMA is dedicated to maintaining quality medical care and improving physician-patient relationships. Toward these goals, it assists its members with certain payment and health care operations activities, and, as such, may, from time to time, receive, have access to, or create, Protected Health Information. B. Physician Practice is a Covered Entity (as defined below) under the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act ("HITECH") at Title XIII of Public Law (collectively, "HIPAA"). C. CMA and Physician Practice are committed to complying with the Privacy Laws, as defined below. D. The parties desire to set forth the terms and conditions of disclosure of Protected Health Information by Physician Practice to CMA and of use and disclosure of Protected Health Information by CMA. Article I. Definitions of Terms Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms have in the Privacy Rule, 45 C.F.R and For purposes of this Agreement: 1.01 Agreement means the existing agreement(s) in effect between Physician Practice and CMA, as amended by this Business Associate Agreement Breach means the acquisition, access, use, or disclosure of PHI in a manner not permitted under the Privacy Rule. Breach does not include: (a) (b) (c) disclosure of PHI where CMA has a good faith belief that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain such information; OR any unintentional acquisition, access, or use of PHI by a Workforce member or person acting under the authority of CMA if: (i) such acquisition, access, or use was made in good faith and within the scope of authority; AND (ii) such acquisition, access, or use does not result in further use or disclosure in a manner not permitted under the Privacy Rule; OR any inadvertent disclosure by a person who is authorized to access PHI at the CMA to another person authorized to access PHI at the Physician Practice or CMA; AND the information received as a result of such disclosure is not further used or disclosed in a manner not permitted under the Privacy Rule Business Associate shall have the meaning given to such term in 45 C.F.R C.F.R. shall mean the Code of Federal Regulations Covered Entity shall have the meaning given to such term in 45 C.F.R Data Aggregation shall have the meaning given to such term in 45 C.F.R Designated Record Set shall have the meaning given to such term in 45 C.F.R

3 1.08 Individual shall have the meaning give to such term in 45 C.F.R and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R (g) Privacy Laws shall mean HIPAA, the HIPAA regulations and any other applicable state or federal laws or regulations affecting or regulating the privacy or security of health information, including the California Confidentiality of Medical Information Act Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 C.F.R part 160 and part 164, subparts A and E Required By Law shall have the same meaning as such term in 45 C.F.R Protected Health Information ("PHI") shall have the meaning given to such term in 45 C.F.R Secretary means the Secretary of the Department of Health and Human Services ("HHS") or his designee Services shall have the meaning set forth in Section Treatment shall have the meaning as such term in 45 C.F.R Unsecured PHI means PHI that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology (e.g., encryption or destruction) specified by the Secretary on the HHS Web site Workforce means employees, volunteers, trainees, and other persons whose conduct, in the performance of work for CMA, is under the direct control of CMA, whether or not they are paid by CMA All references to the C.F.R. are to their then current version. Article II. Obligations of CMA Permitted Uses and Disclosures. CMA shall not use or disclose PHI received or created pursuant to this Agreement except as permitted or required by this Agreement or as Required by Law. CMA shall comply with the privacy requirements of HIPAA that are applicable to Covered Entities as required by 42 U.S.C CMA may use PHI to: (a) assist Physician Practice obtain coverage and payment for services rendered; (b) to advocate on Physician Practice's behalf with respect to other health care operations issues, including, but not limited to, issues involving audits, health plan and IPA bankruptcies, coding and documentation, managed care and other contracts, practice management, credentialing, peer review and licensure; (c) to perform Data Aggregation as permitted under the Privacy Rule (collectively, the "Services") CMA's Operations Permitted Uses of PHI. CMA may use the PHI it obtains or creates in its capacity as a Business Associate for the proper management and administration of CMA or to carry out CMA's legal responsibilities CMA's Operations Permitted Disclosures of PHI. CMA may disclose the PHI it obtains or creates in its capacity as a Business Associate if such disclosure is necessary for the CMA's proper management and administration or to carry out the CMA's legal responsibilities, and: (a) (b) the disclosure is required by law; or CMA obtains reasonable assurances from the recipient of the PHI that the PHI will be held confidentially and used or further disclosed only as required by law or with such further authorizations required by law, and any such disclosure shall be only for the purpose for which it was initially disclosed to the recipient; and the recipient notifies the CMA (and CMA 2

4 in turn notifies Physician Practice) of any instances of which it is aware in which the confidentiality of the PHI has been breached. Except for disclosures for Treatment purposes, CMA and its agents shall use, disclose, or request only the limited data set (as defined in 45 C.F.R (e)(2)), or if that is inadequate, the minimum PHI necessary to accomplish the intended purpose of that use, disclosure or request. The party disclosing the PHI shall determine what constitutes the minimum necessary to accomplish the intended purpose of the disclosure. CMA understands that the HHS Secretary is mandated to issue guidance on what constitutes "minimum necessary," and agrees that CMA and its agents will be bound by that guidance when it is issued and becomes effective Access to PHI by Individuals. CMA shall cooperate with Physician Practice to fulfill all requests by Individuals for access to the Individual's PHI that are approved by Physician Practice as required by 45 C.F.R and California law. CMA shall forward copies of PHI in CMA's possession if requested by Physician Practice to provide copies to patients of the Physician Practice within five (5) business days of such request. If CMA receives a request from an Individual for access to PHI, CMA immediately shall forward such request to Physician Practice. Physician Practice shall be solely responsible for determining the scope of PHI and Designated Record Set with respect to each request by an Individual for access to PHI Access to CMA's Books and Records. To the extent required by the Privacy Rule, CMA shall make its internal practices, books and records relating to the use and disclosure of PHI received from, or created or received by CMA on behalf of Physician Practice available to the Secretary, in a time and manner designated by the Physician Practice or the Secretary, as needed to permit the Secretary to determine Physician Practice's compliance with the Privacy Rule Amendment of PHI. To the extent it possesses a Designated Record Set, CMA shall incorporate all amendments or addenda to PHI received from Physician Practice Disclosure Accounting. In the event that CMA makes any disclosures of PHI that are subject to the accounting requirements of 45 C.F.R , CMA promptly shall report to Physician Practice and maintain a record of each such disclosure, including the name of the Individual, the date of the disclosure, the name and, if available, the address of the recipient of the PHI, a brief description of the PHI disclosed and a brief description of the purpose of the disclosure. CMA shall maintain this record for a period of six (6) years and make available to Physician Practice upon request in an electronic format so that Physician Practice may meet its disclosure accounting obligations under 45 C.F.R CMA understands that the Secretary is mandated to adopt rules expanding the disclosure accounting obligations applicable to physician practices that maintain EHRs, and agrees that CMA will be bound by those rules when they are issued and become effective Security Safeguards. CMA shall comply with the security requirements of HIPAA that are applicable to Covered Entities as required by 42 U.S.C , including, without limitation: (a) (b) (c) Implementing, maintaining and using appropriate and effective administrative, technical and physical safeguards to reasonably preserve the confidentiality, integrity and availability of any electronic PHI as required by the security standards set forth in 45 C.F.R , , and ; Complying with the policies and procedures and documentation requirements of the HIPAA Security Rule, including 45 C.F.R , as and when required by HIPAA; Reporting to Physician Practice any security incident immediately upon becoming aware of such incident. In addition, CMA agrees to (a) maintain written documentation of its policies and procedures, and of any action, activity, or assessment which the HIPAA Security Rule requires to be documented, (b) retain this documentation for six (6) years from the date of its creation or the date when it last was effective, whichever is later, (c) make this documentation available to those persons responsible for implementing 3

5 the procedures to which the documentation pertains, and (d) review this documentation periodically, and update it as needed in response to environmental or operational changes affecting the security of the electronic protected health information Mitigation. CMA shall mitigate, to the extent practicable, any harmful effect that is known to CMA of a use or disclosure of PHI by CMA in violation of the requirements of this Agreement Reports of Non-Permitted Use or Disclosure. CMA shall report to Physician Practice any use or disclosure of PHI not provided for by this Agreement. In addition, CMA shall, following discovery of a Breach of Unsecured PHI, promptly notify Physician Practice of such Breach as and when required by 42 U.S.C Sale of PHI. CMA will comply with any rule adopted by the HHS Secretary regarding the sale of PHI as soon as it becomes effective. CMA shall comply with the prohibition on the sale of electronic health records and PHI set forth in 42 U.S.C (d) Agents. CMA shall require that any subcontractors or other agents to whom it provides PHI received from, or created or received by CMA on behalf of Physician Practice agree in writing to the same use, request and disclosure restrictions imposed on CMA by this Agreement Ownership of Information. All PHI shall be deemed owned by the Physician Practice unless otherwise agreed in writing. During the term of this Agreement, CMA and any authorized subcontractors or other agents shall have the right to use the PHI solely as specified by this Agreement. CMA and its agents shall have the right to de-identify the PHI at CMA's option, in accordance with 45 C.F.R (b) Additional Obligations. CMA will be held to the same standards as Physician Practice to rectify a pattern of activity or practice that constitutes a material breach or violation of CMA's obligation under this Agreement. CMA will be subject to the same penalties as a covered entity for any violation of the HIPAA Privacy or Security requirements, and CMA will also be subject to periodic audits by the HHS Secretary. Article III. Obligations of Physician Practice Notice of Privacy Practices. Physician Practice shall provide CMA with a copy of Physician Practice's Notice of Privacy Practices upon request and inform CMA of any changes to such Notice of Privacy Practices that affect CMA Notice of Changes. Physician Practice shall provide CMA with any changes in, or revocation of, permission by Individual to use or disclose PHI, if such changes affect CMA's permitted or required uses and disclosures Notice of Restrictions. Physician Practice shall notify CMA of any restriction to the use or disclosure of PHI that Physician Practice has agreed to in accordance with 45 C.F.R Impermissible Requests. Physician Practice shall not ask or require CMA to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by a Covered Entity. Article IV. Term and Termination Term. The Term of this Agreement shall be effective as of the Effective Date, and shall remain in effect, except as otherwise provided herein, for so long as the Physician Practice is a member of the CMA Termination for Breach of Privacy or Security. Upon Physician Practice's determination of a material breach of this Agreement by CMA, Physician Practice shall either: (a) provide an opportunity for CMA to cure the breach or end the violation and terminate this Agreement if CMA does not cure the breach or end the violation within the time specified by Physician Practice; or (b) immediately terminate this Agreement 4

6 if CMA has breached a material term of this Agreement and cure is not possible. Physician Practice shall give notice to CMA of the existence of an alleged breach and shall provide CMA with a reasonable opportunity to dispute the existence of such breach Effects of Termination; Disposal of PHI. Upon termination of this Agreement, to the extent is it feasible to do so, CMA shall recover and destroy all PHI that is in its possession or the possession of its subcontractors or agents that CMA obtained or maintained pursuant to this Agreement on behalf of the Physician Practice. However, the parties agree that, because of the nature of CMA's advocacy activities, it may not be feasible for CMA to accomplish this. Therefore, CMA shall extend, and require that its subcontractors and agents agree to the extension of all protections, limitations and restrictions required by this Agreement until the PHI is destroyed. This section shall survive the termination of this Agreement. Article V. Miscellaneous Notices. Any notice required to be given pursuant to the terms and provisions of this Agreement shall be in writing and may be either personally delivered or sent by registered or certified mail in the United States Postal Service, Return Receipt Requested, postage prepaid, addressed to each party at the addresses maintained by the CMA. Any such notice shall be deemed to have been given, if mailed as provided herein, as of the date mailed Change in Law. CMA and Physician Practice shall cooperate with each other in good faith to amend this Agreement as necessary to comply with any subsequent changes or clarifications of the Privacy Laws Intent to Comply with Laws. This Agreement shall be construed consistently with all Privacy Laws and in favor of the protection of PHI. All other aspects of this Agreement shall be governed under the laws of the State of California and venue for any actions relating to this agreement shall be proper in Sacramento County, California Execution. By signature below the undersigned warrant that they have the authority to enter into this Agreement individually and/or in any applicable representative capacity. Signatures may be exchanged by facsimile or by electronic mail. CMA / S / Dustin Corcoran Executive Vice-President & CEO PHYSICIAN PRACTICE Signature: Printed Name: Practice Name: Date: 5

SaaS. Business Associate Agreement

SaaS. Business Associate Agreement SaaS Business Associate Agreement This Business Associate Agreement ( BA Agreement ) becomes effective pursuant to the terms of Section 5 of the End User Service Agreement ( EUSA ) between Customer ( Covered

More information

This form may not be modified without prior approval from the Department of Justice.

This form may not be modified without prior approval from the Department of Justice. This form may not be modified without prior approval from the Department of Justice. Delete this header in execution (signature) version of agreement. HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate

More information

SAMPLE BUSINESS ASSOCIATE AGREEMENT

SAMPLE BUSINESS ASSOCIATE AGREEMENT SAMPLE BUSINESS ASSOCIATE AGREEMENT THIS AGREEMENT IS TO BE USED ONLY AS A SAMPLE IN DEVELOPING YOUR OWN BUSINESS ASSOCIATE AGREEMENT. ANYONE USING THIS DOCUMENT AS GUIDANCE SHOULD DO SO ONLY IN CONSULT

More information

FirstCarolinaCare Insurance Company Business Associate Agreement

FirstCarolinaCare Insurance Company Business Associate Agreement FirstCarolinaCare Insurance Company Business Associate Agreement THIS BUSINESS ASSOCIATE AGREEMENT ("Agreement"), is made and entered into as of, 20 (the "Effective Date") between FirstCarolinaCare Insurance

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Agreement ( Agreement ) is made and entered into this day of [Month], [Year] by and between [Business Name] ( Covered Entity ), [Type of Entity], whose business address

More information

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Agreement is entered into as of ("Effective Date"), between ( Covered Entity ), and ( Business Associate ). RECITALS WHEREAS, Business Associate provides services on behalf

More information

Infinedi HIPAA Business Associate Agreement RECITALS SAMPLE

Infinedi HIPAA Business Associate Agreement RECITALS SAMPLE Infinedi HIPAA Business Associate Agreement This Business Associate Agreement ( Agreement ) is entered into this day of, 20 between ( Company ) and Infinedi, LLC, a Limited Liability Corporation, ( Contractor

More information

Disclaimer: Template Business Associate Agreement (45 C.F.R. 164.308)

Disclaimer: Template Business Associate Agreement (45 C.F.R. 164.308) HIPAA Business Associate Agreement Sample Notice Disclaimer: Template Business Associate Agreement (45 C.F.R. 164.308) The information provided in this document does not constitute, and is no substitute

More information

BUSINESS ASSOCIATE AGREEMENT. Recitals

BUSINESS ASSOCIATE AGREEMENT. Recitals BUSINESS ASSOCIATE AGREEMENT This Agreement is executed this 8 th day of February, 2013, by BETA Healthcare Group. Recitals BETA Healthcare Group consists of BETA Risk Management Authority (BETARMA) and

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ("BA AGREEMENT") supplements and is made a part of any and all agreements entered into by and between The Regents of the University

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement (the Agreement ), is made and is effective as of this day of, 2013 ( Effective Date ), between, located at ( Business Associate

More information

BUSINESS ASSOCIATE AGREEMENT. Business Associate. Business Associate shall mean.

BUSINESS ASSOCIATE AGREEMENT. Business Associate. Business Associate shall mean. BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement is made as of the day of, 2010, by and between Methodist Lebonheur Healthcare, on behalf of itself and all of its affiliates ( Covered Entity

More information

SAMPLE BUSINESS ASSOCIATE AGREEMENT

SAMPLE BUSINESS ASSOCIATE AGREEMENT SAMPLE BUSINESS ASSOCIATE AGREEMENT This is a draft business associate agreement based on the template provided by HHS. It is not intended to be used as is and you should only use the agreement after you

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( BAA ) is effective ( Effective Date ) by and between ( Covered Entity ) and Egnyte, Inc. ( Egnyte or Business Associate ). RECITALS

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is by and between ( Covered Entity )and CONEX Med Pro Systems ( Business Associate ). This Agreement has been attached to,

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is entered into on [Month], [Day] 2014 (the effective Date ), by and between Accreditation Association for Ambulatory Health

More information

H I P AA B U S I N E S S AS S O C I ATE AGREEMENT

H I P AA B U S I N E S S AS S O C I ATE AGREEMENT H I P AA B U S I N E S S AS S O C I ATE AGREEMENT This HIPAA BUSINESS ASSOCIATE AGREEMENT (the BAA ) is entered into by and between Opticare of Utah, Inc. ( Covered Entity ), and,( Business Associate ).

More information

BUSINESS ASSOCIATE AGREEMENT BETWEEN AND COMMISSION ON ACCREDITATION, AMERICAN PSYCHOLOGICAL ASSOCIATION

BUSINESS ASSOCIATE AGREEMENT BETWEEN AND COMMISSION ON ACCREDITATION, AMERICAN PSYCHOLOGICAL ASSOCIATION BUSINESS ASSOCIATE AGREEMENT BETWEEN AND COMMISSION ON ACCREDITATION, AMERICAN PSYCHOLOGICAL ASSOCIATION This Agreement governs the provision of Protected Health Information ("PHI") (as defined in 45 C.F.R.

More information

University Healthcare Physicians Compliance and Privacy Policy

University Healthcare Physicians Compliance and Privacy Policy Page 1 of 11 POLICY University Healthcare Physicians (UHP) will enter into business associate agreements in compliance with the provisions of the Health Insurance Portability and Accountability Act of

More information

BREVIUM HIPAA BUSINESS ASSOCIATE TERMS AND CONDITIONS

BREVIUM HIPAA BUSINESS ASSOCIATE TERMS AND CONDITIONS BREVIUM HIPAA BUSINESS ASSOCIATE TERMS AND CONDITIONS The following HIPAA Business Associate Terms and Conditions (referred to hereafter as the HIPAA Agreement ) are part of the Brevium Software License

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is effective as of, 200 ( Effective Date ), and entered into by and between, whose address is ( Business Associate ) and THE

More information

Business Associate and Data Use Agreement

Business Associate and Data Use Agreement Business Associate and Data Use Agreement This Business Associate and Data Use Agreement (the Agreement ) is entered into by and between ( Covered Entity ) and HealtHIE Nevada ( Business Associate ). W

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT THIS HIPAA BUSINESS ASSOCIATE AGREEMENT ( BAA ) is entered into effective the day of, 20 ( Effective Date ), by and between the Regents of the University of Michigan,

More information

Business Associate Agreement Involving the Access to Protected Health Information

Business Associate Agreement Involving the Access to Protected Health Information School/Unit: Rowan University School of Osteopathic Medicine Vendor: Business Associate Agreement Involving the Access to Protected Health Information This Business Associate Agreement ( BAA ) is entered

More information

Sample Business Associate Agreement Provisions

Sample Business Associate Agreement Provisions Sample Business Associate Agreement Provisions Words or phrases contained in brackets are intended as either optional language or as instructions to the users of these sample provisions. Definitions Catch-all

More information

BUSINESS ASSOCIATE ADDENDUM

BUSINESS ASSOCIATE ADDENDUM BUSINESS ASSOCIATE ADDENDUM This BA Agreement, effective as of the effective date of the Terms of Use, adds to and is made part of the Terms of Use by and between Business Associate and Covered Entity.

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT 1. DEFINITIONS: 1.1 Undefined Terms: Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms defined by the Health Insurance Portability

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( BA Agreement ) is entered into by Medtep Inc., a Delaware corporation ( Business Associate ) and the covered entity ( Covered Entity

More information

BUSINESS ASSOCIATE AGREEMENT Tribal Contract

BUSINESS ASSOCIATE AGREEMENT Tribal Contract DEPARTMENT OF HEALTH SERVICES Division of Enterprise Services F-00714 (08/2013) STATE OF WISCONSIN BUSINESS ASSOCIATE AGREEMENT Tribal Contract This Business Associate Agreement is made between the Wisconsin

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is entered into by and between Professional Office Services, Inc., with principal place of business at PO Box 450, Waterloo,

More information

Iowa Health Information Network BUSINESS ASSOCIATE AGREEMENT

Iowa Health Information Network BUSINESS ASSOCIATE AGREEMENT Iowa Health Information Network BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (the Agreement ) is made entered into and effective on the day of, 201_ ( Effective Date ) by and between

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (hereinafter Agreement ) is between COVERED ENTITY NAME (hereinafter Covered Entity ) and BUSINESS ASSOCIATE NAME (hereinafter Business

More information

HIPAA Business Associate Contract. Definitions

HIPAA Business Associate Contract. Definitions HIPAA Business Associate Contract Definitions Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the Privacy Rule. Examples of specific definitions:

More information

BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA)

BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA) BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA) This Business Associate Agreement (the Agreement ) is made and entered into as of [Date] (hereinafter Effective

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) by and between (hereinafter known as Covered Entity ) and Office Ally, LLC. (hereinafter known as Business Associate ), and

More information

Tulane University. Tulane University Business Associates Agreement SCOPE OF POLICY STATEMENT OF POLICY IMPLEMENTATION OF POLICY

Tulane University. Tulane University Business Associates Agreement SCOPE OF POLICY STATEMENT OF POLICY IMPLEMENTATION OF POLICY Tulane University DEPARTMENT: General Counsel s POLICY DESCRIPTION: Business Associates Office -- HIPAA Agreement PAGE: 1 of 1 APPROVED: April 1, 2003 REVISED: November 29, 2004, December 1, 2008, October

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) by and between Drexel University ( Hybrid Entity ), with a principal address at 3141 Chestnut Street, Philadelphia, PA 19104,

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the "Agreement") is made and entered into this day of,, by and between Quicktate and idictate ("Business Associate") and ("Covered Entity").

More information

HIPAA PRIVACY AND SECURITY RULES BUSINESS ASSOCIATE AGREEMENT BETWEEN. Stewart C. Miller & Co., Inc. (Business Associate) AND

HIPAA PRIVACY AND SECURITY RULES BUSINESS ASSOCIATE AGREEMENT BETWEEN. Stewart C. Miller & Co., Inc. (Business Associate) AND HIPAA PRIVACY AND SECURITY RULES BUSINESS ASSOCIATE AGREEMENT BETWEEN Stewart C. Miller & Co., Inc. (Business Associate) AND City of West Lafayette Flexible Spending Plan (Covered Entity) TABLE OF CONTENTS

More information

Louisiana State University System

Louisiana State University System PM-36: Attachment 4 Business Associate Contract Addendum On this day of, 20, the undersigned, [Name of Covered Entity] ("Covered Entity") and [Name of Business Associate] ("Business Associate") have entered

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT is made and entered into as of the day of, 2013 ( Effective Date ), by and between [Physician Practice] on behalf of itself and each of its

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT THIS HIPAA BUSINESS ASSOCIATE AGREEMENT ("Agreement") is made and is effective as of the date of electronic signature("effective Date") between Name of Organization ("Covered

More information

HIPAA Business Associate Agreement

HIPAA Business Associate Agreement HIPAA Business Associate Agreement This HIPAA Business Associate Agreement (the Agreement ) is executed by the parties on the dates shown beneath their respective signature lines, but is effective as of,

More information

Please print the attached document, sign and return to privacy@covermymeds.com or contact Erica Van Treese, Account Manager, Provider Relations &

Please print the attached document, sign and return to privacy@covermymeds.com or contact Erica Van Treese, Account Manager, Provider Relations & Please print the attached document, sign and return to privacy@covermymeds.com or contact Erica Van Treese, Account Manager, Provider Relations & Solutions. Office: 866-452-5017, Fax: 615-379-2541, evantreese@covermymeds.com

More information

Health Partners HIPAA Business Associate Agreement

Health Partners HIPAA Business Associate Agreement Health Partners HIPAA Business Associate Agreement This HIPAA Business Associate Agreement ( Agreement ) by and between Health Partners of Philadelphia, Inc., the Covered Entity (herein referred to as

More information

The Accreditation Association for Ambulatory Health Care (AAAHC) is a Business Associate as defined in the HIPAA Privacy Rule:

The Accreditation Association for Ambulatory Health Care (AAAHC) is a Business Associate as defined in the HIPAA Privacy Rule: HIPAA BUSINESS ASSOCIATE AGREEMENT The Accreditation Association for Ambulatory Health Care (AAAHC) is a Business Associate as defined in the HIPAA Privacy Rule: http://www.hhs.gov/ocr/privacy/hipaa/faq/business_associates/238.html

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement, dated as of September 22, 2014 ( BA Agreement ), supplements and is made a part of the Services Agreement (as defined below) by and

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ) is entered into by and between (the Covered Entity ), and Iowa State Association of Counties (the Business Associate ). RECITALS

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This BUSINESS ASSOCIATE AGREEMENT ( BAA ) is entered into as of ( Effective Date ) by and between ( Covered Entity ) and American Academy of Sleep Medicine ( Business Associate

More information

HIPAA Compliance And Participation in the National Oncologic Pet Registry Project

HIPAA Compliance And Participation in the National Oncologic Pet Registry Project HIPAA Compliance And Participation in the National Oncologic Pet Registry Project Your facility has indicated its willingness to participate in the National Oncologic PET Registry Project (NOPR) sponsored

More information

Business Associate Agreement

Business Associate Agreement This Business Associate Agreement Is Related To and a Part of the Following Underlying Agreement: Effective Date of Underlying Agreement: Vendor: Business Associate Agreement This Business Associate Agreement

More information

STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES BUSINESS ASSOCIATE ADDENDUM

STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES BUSINESS ASSOCIATE ADDENDUM STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES BUSINESS ASSOCIATE ADDENDUM BETWEEN The Division of Health Care Financing and Policy Herein after referred to as the Covered Entity and (Enter Business

More information

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Business Associate Agreement (the Agreement ) is made by and between Business Associate, [Name of Business Associate], and Covered Entity, The Connecticut Center for Health,

More information

Business Associates Agreement

Business Associates Agreement Business Associates Agreement This Business Associate Agreement (the Agreement ) between Customer,( Covered Entity ) and Kareo ( Business Associate ) will be in effect during any such time period that

More information

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Business Associate Agreement (this "Agreement") is made as of, 201_ (the Effective Date ), and is entered into between ( Covered Entity ) and Delta Business System, Inc.

More information

BUSINESS ASSOCIATE AGREEMENT WITH TRANSFUSION FACILITIES

BUSINESS ASSOCIATE AGREEMENT WITH TRANSFUSION FACILITIES 1 BUSINESS ASSOCIATE AGREEMENT WITH TRANSFUSION FACILITIES This BUSINESS ASSOCIATE AGREEMENT (this Agreement ) is entered into as of the date first written in the signature block below (the Effective Date

More information

CONTRACT ADDENDUM BUSINESS ASSOCIATE CONTRACT 1

CONTRACT ADDENDUM BUSINESS ASSOCIATE CONTRACT 1 CONTRACT ADDENDUM BUSINESS ASSOCIATE CONTRACT 1 THIS AGREEMENT is entered into on ( Effective Date ) by and between LaSalle County Health Department, hereinafter called Covered Entity and, hereinafter

More information

HIPAA Information. Who does HIPAA apply to? What are Sync.com s responsibilities? What is a Business Associate?

HIPAA Information. Who does HIPAA apply to? What are Sync.com s responsibilities? What is a Business Associate? HIPAA Information Who does HIPAA apply to? HIPAA applies to all Covered Entities (entities that collect, access, use and/or disclose Protected Health Data (PHI) and are subject to HIPAA regulations). What

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Addendum is made part of the agreement between Boston Medical Center ("Covered Entity ) and ( Business Associate"), dated [the Underlying Agreement ]. In connection with

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT THIS IS A TEMPLATE ONLY. CERTAIN STATES MAY NOT PERMIT THE TYPES OF ACTIVITIES ALLOWED HEREUNDER RELATING TO PROTECTED HEALTH INFORMATION. THUS THIS AGREEMENT MAY NEED TO BE MODIFIED IN ORDER TO COMPLY

More information

Name of Other Party: Address of Other Party: Effective Date: Reference Number as applicable:

Name of Other Party: Address of Other Party: Effective Date: Reference Number as applicable: PLEASE NOTE: THIS DOCUMENT IS SUBMITTED AS A SAMPLE, FOR INFORMATIONAL PURPOSES ONLY TO ABC ORGANIZATION. HIPAA SOLUTIONS LC IS NOT ENGAGED IN THE PRACTICE OF LAW IN ANY STATE, JURISDICTION, OR VENUE OF

More information

BUSINESS ASSOCIATE ADDENDUM

BUSINESS ASSOCIATE ADDENDUM BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum ( Addendum ) is entered into this day of 2014. Perry Memorial Hospital ( Covered Entity ) and [ABC Company] ( Business Associate ) referred

More information

ADDENDUM 5 - BUSINESS ASSOCIATE AGREEMENT

ADDENDUM 5 - BUSINESS ASSOCIATE AGREEMENT ADDENDUM 5 - BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the BAA ) is effective as of (the Effective Date ) and is entered into by and between, with an address of (the Covered Entity

More information

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This BUSINESS ASSOCIATE AGREEMENT (the "Agreement") is entered into by and between the Board of Regents of the University of Wisconsin System on behalf of the [insert name

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is entered between ("Covered Entity" or "CE") and, ("Business Associate" or "BA"), collectively the Parties, who agree as follows:

More information

BUSINESS ASSOCIATE AGREEMENT HIPAA Omnibus Rule (Final Rule)

BUSINESS ASSOCIATE AGREEMENT HIPAA Omnibus Rule (Final Rule) BUSINESS ASSOCIATE AGREEMENT HIPAA Omnibus Rule (Final Rule) This Business Associate Agreement (the Agreement ), dated September 9, 2013, is entered into by and between ( Covered Entity ) and Schuster

More information

HIPAA BUSINESS ASSOCIATE ADDENDUM (Privacy & Security) I. Definitions

HIPAA BUSINESS ASSOCIATE ADDENDUM (Privacy & Security) I. Definitions HIPAA BUSINESS ASSOCIATE ADDENDUM (Privacy & Security) I. Definitions A. Business Associate. Business Associate shall have the meaning given to such term under the Privacy and Security Rules, including,

More information

DRAFT BUSINESS ASSOCIATES AGREEMENT

DRAFT BUSINESS ASSOCIATES AGREEMENT DRAFT BUSINESS ASSOCIATES AGREEMENT THIS AGREEMENT is made this day of, 20, by and among, a Corporation organized under the laws of the State of (hereinafter known as "Covered Entity") and organized under

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) between Inphonite, LLC ( Business Associate and you, as our Customer ( Covered Entity ) (each individually, a Party, and collectively,

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (Hereinafter "Agreement") dated as of, 2013, is made by and between (Hereinafter Covered Entity ) and (Hereinafter Business Associate ). ARTICLE

More information

ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT FOR HIPAA PRIVACY/SECURITY RULES

ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT FOR HIPAA PRIVACY/SECURITY RULES ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT FOR HIPAA PRIVACY/SECURITY RULES This Addendum is entered into effective as of, by and among Delta Dental of Virginia ("Business Associate"), and ( Covered

More information

BUSINESS ASSOCIATE AND DATA USE AGREEMENT NAME OF COVERED ENTITY: COVERED ENTITY FEIN/TAX ID: COVERED ENTITY ADDRESS:

BUSINESS ASSOCIATE AND DATA USE AGREEMENT NAME OF COVERED ENTITY: COVERED ENTITY FEIN/TAX ID: COVERED ENTITY ADDRESS: BUSINESS ASSOCIATE AND DATA USE AGREEMENT NAME OF COVERED ENTITY: COVERED ENTITY FEIN/TAX ID: COVERED ENTITY ADDRESS:, City State Zip This Business Associate and Data Use Agreement ( Agreement ) is effective

More information

Rutgers University HIPAA BUSINESS ASSOCIATE AGREEMENT

Rutgers University HIPAA BUSINESS ASSOCIATE AGREEMENT Rutgers University HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement Is Related To and a Part of the Following Underlying Agreement: Effective Date of Underlying Agreement: School/Unit:

More information

INTERMACS REGISTRY BUSINESS ASSOCIATE AGREEMENT

INTERMACS REGISTRY BUSINESS ASSOCIATE AGREEMENT INTERMACS REGISTRY BUSINESS ASSOCIATE AGREEMENT This Agreement dated as of is made by and between The Board of Trustees of the University of Alabama, on behalf of INTERMACS Registry ( Business Associate

More information

LCD SOLUTIONS and CLICKTATE.COM BUSINESS ASSOCIATE AGREEMENT and DISCLOSURE of RIGHTS to COVERED ENTITIES

LCD SOLUTIONS and CLICKTATE.COM BUSINESS ASSOCIATE AGREEMENT and DISCLOSURE of RIGHTS to COVERED ENTITIES LCD SOLUTIONS and CLICKTATE.COM BUSINESS ASSOCIATE AGREEMENT and DISCLOSURE of RIGHTS to COVERED ENTITIES This agreement ("Agreement") is effective upon its execution and delivery to LCD SOLUTIONS, INC.

More information

This is a "preview " of the BAA agreement. You'll be able to sign the BAA electronically after you upgrade to the Powerhouse Player plan.

This is a preview  of the BAA agreement. You'll be able to sign the BAA electronically after you upgrade to the Powerhouse Player plan. BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is entered into as of (the Effective Date ), by and between ("Covered Entity") and Acuity Scheduling, Inc. ("Business Associate").

More information

UNIVERSITY PHYSICIANS OF BROOKLYN HIPAA BUSINESS ASSOCIATE AGREEMENT CONTRACT NO(S):

UNIVERSITY PHYSICIANS OF BROOKLYN HIPAA BUSINESS ASSOCIATE AGREEMENT CONTRACT NO(S): UNIVERSITY PHYSICIANS OF BROOKLYN HIPAA BUSINESS ASSOCIATE AGREEMENT CONTRACT NO(S): THIS AGREEMENT is made by and between UNIVERSITY PHYSICIANS OF BROOKLYN, INC., located at 450 Clarkson Ave., Brooklyn,

More information

AMENDMENT TO IMPLEMENT HIPAA BUSINESS ASSOCIATE REQUIREMENTS (UPB=COVERED ENTITY) CONTRACT NO(S).:

AMENDMENT TO IMPLEMENT HIPAA BUSINESS ASSOCIATE REQUIREMENTS (UPB=COVERED ENTITY) CONTRACT NO(S).: AMENDMENT TO IMPLEMENT HIPAA BUSINESS ASSOCIATE REQUIREMENTS (UPB=COVERED ENTITY) CONTRACT NO(S).: THIS AMENDMENT is made as by and between UNIVERSITY PHYSICIANS OF BROOKLYN, INC. located at 450 Clarkson

More information

Model Business Associate Agreement

Model Business Associate Agreement Model Business Associate Agreement Instructions: The Texas Health Services Authority (THSA) has developed a model BAA for use between providers (Covered Entities) and HIEs (Business Associates). The model

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is between you, a healthcare provider, its employees and agents ( Covered Entity ) and Doc Halo, LLC ( Business Associate ).

More information

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) TERMS AND CONDITIONS FOR BUSINESS ASSOCIATES

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) TERMS AND CONDITIONS FOR BUSINESS ASSOCIATES HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) TERMS AND CONDITIONS FOR BUSINESS ASSOCIATES I. Overview / Definitions The Health Insurance Portability and Accountability Act is a federal law

More information

OFFICE OF CONTRACT ADMINISTRATION 60400 PURCHASING DIVISION. Appendix A HEALTHCARE INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA)

OFFICE OF CONTRACT ADMINISTRATION 60400 PURCHASING DIVISION. Appendix A HEALTHCARE INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) Appendix A HEALTHCARE INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum ( Addendum ) supplements and is made a part of the contract ( Contract

More information

BUSINESS ASSOCIATE ADDENDUM. WHEREAS, Provider (as defined below) has a contractual relationship with FHCCP requiring this Addendum;

BUSINESS ASSOCIATE ADDENDUM. WHEREAS, Provider (as defined below) has a contractual relationship with FHCCP requiring this Addendum; BUSINESS ASSOCIATE ADDENDUM This BUSINESS ASSOCIATE ADDENDUM (this Addendum ) is made and entered into as of July 1, 2012, ( Effective Date ) and supplements and is made a part of the services agreement

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT The parties to this ( Agreement ) are, a _New York_ corporation ( Business Associate ) and ( Client ) you, as a user of our on-line health record system (the "System"). BY

More information

Snake River School District No. 52 HIPAA BUSINESS ASSOCIATE AGREEMENT (See also Policy No. 7436, HIPAA Privacy Rule)

Snake River School District No. 52 HIPAA BUSINESS ASSOCIATE AGREEMENT (See also Policy No. 7436, HIPAA Privacy Rule) 5450F1 (page 1 of 6) Snake River School District No. 52 HIPAA BUSINESS ASSOCIATE AGREEMENT (See also Policy No. 7436, HIPAA Privacy Rule) THIS AGREEMENT is entered into on this day of, 20 by and between

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT Please complete the following and return signed via Fax: 919-785-1205 via Mail: Aesthetic & Reconstructive Plastic Surgery, PLLC 2304 Wesvill Court Suite 360 Raleigh, NC 27607

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is effective as of (the Agreement Effective Date ) by and between the Administrators of the Tulane Educational Fund acting

More information

A How-To Guide for Updating HIPAA Policies & Procedures to Align with ARRA Health Care Provider Edition Version 1

A How-To Guide for Updating HIPAA Policies & Procedures to Align with ARRA Health Care Provider Edition Version 1 A How-To Guide for Updating HIPAA Policies & Procedures to Align with ARRA Health Care Provider Edition Version 1 Policy and Procedure Templates Reflects modifications published in the Federal Register

More information

BUSINESS ASSOCIATE ADDENDUM

BUSINESS ASSOCIATE ADDENDUM BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum ( Addendum ) adds to and is made a part of the Q- global Subscription and License Agreement by and between NCS Pearson, Inc. ( Business Associate

More information

HIPAA Business Associate Agreement

HIPAA Business Associate Agreement HIPAA Business Associate Agreement User of any Nemaris Inc. (Nemaris) products or services including but not limited to Surgimap Spine, Surgimap ISSG, Surgimap SRS, Surgimap Office, Surgimap Ortho, Surgimap

More information

BUSINESS ASSOCIATE AGREEMENT RECITALS

BUSINESS ASSOCIATE AGREEMENT RECITALS BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( Agreement ) is entered into and made this day of, 201_, ( Effective Date ) by and among Interpra, Inc., S & S Health Products, Inc.

More information

BUSINESS ASSOCIATE AGREEMENT. (Contractor name and address), hereinafter referred to as Business Associate;

BUSINESS ASSOCIATE AGREEMENT. (Contractor name and address), hereinafter referred to as Business Associate; BUSINESS ASSOCIATE AGREEMENT (Agreement #) THIS DOCUMENT CONSTITUTES AN AGREEMENT BETWEEN: AND (Contractor name and address), hereinafter referred to as Business Associate; The Department of Behavioral

More information

BUSINESS ASSOCIATE AGREEMENT ( BAA )

BUSINESS ASSOCIATE AGREEMENT ( BAA ) BUSINESS ASSOCIATE AGREEMENT ( BAA ) Pursuant to the terms and conditions specified in Exhibit B of the Agreement (as defined in Section 1.1 below) between EMC (as defined in the Agreement) and Subcontractor

More information

HSHS BUSINESS ASSOCIATE AGREEMENT BACKGROUND AND RECITALS

HSHS BUSINESS ASSOCIATE AGREEMENT BACKGROUND AND RECITALS HSHS BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement, ( Agreement ) is entered into on the date(s) set forth below by and between Hospital Sisters Health System on its own behalf and

More information

FORM OF HIPAA BUSINESS ASSOCIATE AGREEMENT

FORM OF HIPAA BUSINESS ASSOCIATE AGREEMENT FORM OF HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is made and entered into to be effective as of, 20 (the Effective Date ), by and between ( Covered Entity ) and

More information

HIPAA Business Associate Agreement

HIPAA Business Associate Agreement HIPAA Business Associate Agreement This HIPAA Business Associate Agreement ( BAA ), effective as of, ( Effective Date ), is made by and between ( Covered Entity ) and da Vinci Motion Graphics, Inc. d/b/a

More information

BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT

BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT This BUSINESS ASSOCIATE AGREEMENT ( Agreement ) dated as of the signature below, (the Effective Date ), is entered into by and between the signing organization

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This Agreement, dated as of, 2015 ("Agreement"), by and between, on its own behalf and on behalf of all entities controlling, under common control with or controlled

More information

PHYSICIANS REIMBURSEMENT FUND, INC. A Risk Retention Group. APPLICATION MD & DO Locum Tenens. 1. First Name: Middle Initial: Last Name:

PHYSICIANS REIMBURSEMENT FUND, INC. A Risk Retention Group. APPLICATION MD & DO Locum Tenens. 1. First Name: Middle Initial: Last Name: PHYSICIANS REIMBURSEMENT FUND, INC. A Risk Retention Group APPLICATION MD & DO Locum Tenens Applicant Information: 1. First Name: Middle Initial: Last Name: CA Medical License #: Expiration Date: Date

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is effective as of, 2013, and is by and between SOUTHWEST DEVELOPMENTAL SERVICES, INC. ( Covered Entity ) and ( Business Associate

More information