FirstCarolinaCare Insurance Company Business Associate Agreement

Size: px
Start display at page:

Download "FirstCarolinaCare Insurance Company Business Associate Agreement"

Transcription

1 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 Company, a North Carolina corporation ("FCC"), and ( Business Associate ) (each a "Party" and collectively the "Parties"). WITNESSETH: WHEREAS, Business Associate provides medical bill auditing, review, and other related services to FCC ( Services ), which involves Business Associate s receipt, creation, use and/or disclosure of certain Protected Health Information (as such term is defined below) for or on behalf of FCC; and WHEREAS, the Parties desire to comply with the requirements of the Health Information Portability and Accountability Act of 1996, as codified at 42 U.S.C. 1320d, et seq. ( HIPAA ), the Health Information Technology Act of 2009, as codified at 42 U.S.C , et seq. ( HITECH ), and any current and future regulations promulgated under either HIPAA or HITECH, including the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164 (collectively referred to herein as the HIPAA Rules ). NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the Parties agree as follows: I. DEFINITIONS A. Breach. Breach shall mean, subject to the exclusions set forth in 45 CFR , the acquisition, access, use, or disclosure of Protected Health Information in a manner not permitted under 45 CFR Part 164, Subpart E, that compromises the security or privacy of such PHI. B. Business Associate. Business Associate shall generally have the same meaning as the term business associate at 45 CFR , and in reference to the party to this Agreement, shall mean Business Associate. C. Covered Entity. Covered Entity shall generally have the same meaning as the term covered entity at 45 CFR , and in reference to the party to this Agreement, shall mean FCC. D. Individual. Individual shall have the same meaning as the term Individual in 45 CFR and shall include a person who qualifies as a personal representative in accordance with 45 CFR (g). E. Protected Health Information or PHI. Protected Health Information or PHI shall have the same meaning as the term Protected Health Information in 45 CFR , limited to the information created or received by Business Associate on behalf of or from Covered Entity. 1

2 F. Secretary. Secretary shall mean the Secretary of the Department of Health and Human Services or his/her designee. G. Security Incident. Security Incident shall mean the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system. H. Unsecured Protected Health Information. Unsecured Protected Health Information shall mean Protected Health Information that is not rendered unusable, unreadable, or indecipherable to unauthorized persons through the use of a technology or methodology specified by the Secretary. Terms used but not otherwise defined in this Agreement shall have the same meaning as given to those terms in the HIPAA Rules. In the event of an inconsistency between the provisions of this Agreement and mandatory provisions of the HIPAA Rules, the HIPAA Rules shall control. Where provisions of this Agreement are different than those mandated in the HIPAA Rules, but are nonetheless permitted by the same, the provisions of this Agreement shall control. II. BUSINESS ASSOCIATE S OBLIGATIONS A. Permitted Use and Disclosure of PHI. Business Associate shall use and disclose PHI only as permitted by this Agreement, or as Required By Law. Except as otherwise limited in this Agreement, Business Associate may: 1. Use or disclose PHI to perform its obligations and functions in order to provide Services to Covered Entity; 2. Use PHI for the proper management and administration of Business Associate or to carry out its legal responsibilities; 3. Disclose PHI for the proper management and administration of Business Associate or to carry out its legal responsibilities, if such disclosure is Required By Law, or if Business Associate obtains the written agreement of the recipient providing (i) reasonable assurances that the recipient will keep the PHI confidential, use or further disclose the PHI only as Required By Law or for the purpose for which it was disclosed to the recipient, and (ii) that the recipient shall immediately notify Business Associate of any instance of which the recipient is aware in which the confidentiality of the PHI has been breached; 4. Use PHI to provide Data Aggregation services to the extent specified in a service agreement; 5. Use or disclose PHI to report violations of the law to law enforcement; and 6. Use PHI to create de-identified information consistent with the standards of 45 CFR B. Safeguards. Business Associate shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the Electronic PHI that Business Associate creates, receives, maintains, or transmits on behalf of Covered Entity, as required by the HIPAA Rules, specifically Subpart C of 45 CFR Part

3 C. Minimum Necessary. Business Associate, and its agents, shall request, use and disclose only the minimum amount of Protected Health Information necessary to accomplish the purpose of the request, use or disclosure. Business Associate understands and agrees that the regulatory definition of minimum necessary is subject to development and change. Business Associate, accordingly, shall keep itself informed of all regulatory guidance issued with respect to what constitutes minimum necessary. D. Prohibited Uses and Disclosures. Business Associate shall not use or disclose PHI for any purpose other than as specifically permitted by this Agreement. Specifically, but without limitation, Business Associate (a) shall not use or disclose PHI for fundraising or marketing purposes, (b) shall not disclose PHI to a health plan for payment or health care operations purposes if Business Associate is made aware that the patient has requested a special restriction on disclosure and has paid out of pocket in full for the health care item or services to which the PHI solely relates, and (c) shall not directly or indirectly receive remuneration in exchange for PHI (which does not affect payment from Covered Entity for Business Associate s Services). Further, to the extent Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 CFR Part 164, Business Associate must comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). E. Agents & Subcontractors. Business Associate shall ensure, in accordance with 45 CFR (e)(1)(ii) and (b)(2), that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees in writing to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. F. Required Reports Regarding Breaches and Security Incidents. 1. Business Associate shall report to Covered Entity any use or disclosure of PHI not provided for in this Agreement of which it becomes aware, including without limitation any Breach of Unsecured Protected Health Information, and any Security Incident involving Electronic PHI, within ten (10) business days after discovery thereof. An act or event shall be considered discovered as of the first day on which the occurrence of the event is known, or reasonably should have been known, to any employee, officer or agent of Business Associate, other than the individual committing the act or event. 2. Business Associate shall report the information described below to Covered Entity within ten (10) business days following discovery of a Breach of Unsecured Protected Health Information, except when despite all reasonable efforts by Business Associate to obtain the information required, circumstances beyond the control of Business Associate necessitate additional time. Under such circumstances, Business Associate shall notify Covered Entity as soon as possible and without unreasonable delay, but in no event later than thirty (30) calendar days from the date of discovery of a Breach. The notice shall include, to the extent possible: i. the identification of each Individual whose Unsecured PHI has been, or is reasonably believed by Business Associate to have been, accessed, acquired, or disclosed during the Breach; ii. the date of the Breach; iii. the date of the discovery of the Breach; 3

4 and iv. a description of the types of Unsecured PHI that were involved; v. such other information available to Business Associate that Covered Entity may by law be required to include in any notification to the Individual, as well as any other details necessary to complete the risk assessment specified in 45 CFR (2). 3. Covered Entity shall be responsible for providing notification to Individuals whose Unsecured PHI has been disclosed, as well as the Secretary and the media, as required by Sec of the HITECH Act, 42 U.S.C In the event that Business Associate is required to provide notification to patients, other individuals or the relevant regulatory agencies regarding a Breach, any such notices must be approved, in advance, by Covered Entity. Covered Entity s approval shall also be required for the manner of delivering notice of a Breach to a patient or other individual. G. Access to PHI. To the extent that Business Associate possesses an applicable Designated Record Set, and within a reasonable amount of time of receipt of a request from Covered Entity to access such PHI, Business Associate shall transmit such information to Covered Entity, to the extent required for Covered Entity s compliance with its obligations under 45 CFR If an Individual requests access to PHI directly from Business Associate, Business Associate will forward such a request to Covered Entity within a reasonable amount of time. Covered Entity will be responsible for making all determinations regarding the granting or denial of an Individual s request, and Business Associate shall make no such determinations. If Business Associate maintains PHI in a Designated Record Set electronically and the Individual requests an electronic copy of such information, Business Associate shall provide such information in electronic format to Covered Entity, in accordance with 45 CFR (c)(2)(ii). If any patient requests an amendment of PHI directly from Business Associate or its agent, Business Associate shall notify Covered Entity in writing within five (5) days of the request. Any approval or denial of amendment to PHI maintained by Business Associate or its agent shall be the responsibility of Covered Entity. H. Amendment of PHI. To the extent that Business Associate possesses an applicable Designated Record Set, and within a reasonable amount of time of receipt of a request from Covered Entity to amend PHI contained in the Designated Record Set, Business Associate shall: 1. Provide such information to Covered Entity for amendment; or 2. If Covered Entity s request includes specific information to be included in the amendment, incorporate such amendment in the PHI maintained by Business Associate as required by 45 CFR Within a reasonable amount of time of receipt of a request by an Individual to Business Associate to amend PHI, Business Associate shall forward to Covered Entity any such requests. Covered Entity shall be responsible for making all determinations regarding amendments to PHI, and Business Associate shall make no such determinations. I. Accounting. Business Associate shall document such disclosures of PHI as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR

5 1. Within a reasonable amount of time of receipt of a notice from Covered Entity requesting an accounting of PHI disclosures, Business Associate shall provide Covered Entity with records of such disclosures containing information as outlined in 45 CFR (b). 2. Within a reasonable amount of time of receipt of a request by an Individual to Business Associate for an accounting of disclosures of PHI, Business Associate shall forward to Covered Entity any such requests within five (5) days of receipt. Covered Entity shall be responsible for providing an accounting of PHI disclosures to the Individual. Business Associate will not provide an accounting of its disclosures directly to the Individual. J. Government Access. Upon reasonable notice and prior written request, Business Associate shall, upon request, make its internal practices, books and records on the use and disclosure of PHI available to Covered Entity and to the Secretary to the extent required for determining Covered Entity s compliance with the HIPAA Rules. Notwithstanding this term, no attorney-client or other applicable legal privilege will be deemed waived by Business Associate as a result of complying with such a request. Business Associate shall concurrently provide Covered Entity with a copy of any PHI that Business Associate provides pursuant to any governmental inquiry. K. Mitigation. Business Associate shall mitigate, to the extent practicable and at its cost, any harmful effects from any use or disclosure of PHI by Business Associate not permitted by this Agreement, regardless of Business Associate s fault or negligence. All such efforts shall be subject to Covered Entity s prior written approval. III. COVERED ENTITY S OBLIGATIONS A. Notice of Change in Privacy Practices. Covered Entity shall notify Business Associate of any limitation(s) in Covered Entity s notice of privacy practices in accordance with 45 CFR , to the extent that such limitation may affect Business Associate s use or disclosure of PHI. B. Notice of Change in Permissions. Covered Entity shall notify Business Associate of any changes in, or revocation of, permission by an Individual to use or disclose PHI, to the extent that such changes may affect Business Associate s use or disclosure of PHI. C. Notice of Change in Use. Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR , to the extent that such restriction may affect Business Associate s use or disclosure of PHI. D. Appropriate Requests. Covered Entity shall not request that Business Associate use or disclose PHI in any manner that would not be permissible under the HIPAA Rules if done by Covered Entity. IV. TERM AND TERMINATION 5

6 A. Term. This Agreement shall become effective on the Effective Date and shall terminate at the time of the termination or expiration of any service agreement entered into by the Parties. B. Termination for Cause. If Covered Entity reasonably determines that Business Associate has materially breached this Agreement, Covered Entity shall: 1. Provide Business Associate with thirty (30) days written notice of the alleged material breach and an opportunity to cure the breach, immediately after which time this Agreement and any affected service agreement shall be automatically terminated if the breach is not cured; or 2. Immediately terminate this Agreement and any affected service agreement if cure is not possible. C. Effect of Termination. Upon termination or expiration of this Agreement, Business Associate shall, at Covered Entity s option, return to Covered Entity or destroy all PHI in Business Associate s possession, and/or in the possession of any subcontractor or agent of Business Associate. Business Associate shall not retain any copies of the PHI. In the event that return or destruction of the PHI is not possible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction of the PHI not feasible. Business Associate shall extend the protections of this Agreement to such PHI that is not returned or destroyed, and limit further uses and disclosures of such PHI to those purposes that make the return or destruction not feasible, for as long as Business Associate maintains such PHI. If Covered Entity elects destruction of the PHI, Business Associate shall certify in writing to Covered Entity that such PHI has been destroyed. The provisions of this Section shall survive termination of this Agreement. V. MISCELLANEOUS A. Amendments. The Agreement may not be modified, nor shall any provision hereof be waived or amended, except in a writing duly signed by authorized representatives of the Parties. The Parties shall amend this Agreement from time to time as is necessary to achieve and maintain compliance with the HIPAA Rules. B. Interpretation. Any ambiguity in this Agreement shall be resolved to permit the Parties to comply with the HIPAA Rules. C. Choice of Law. This Agreement shall be governed by the laws of the State of North Carolina without regard to conflict of laws principles thereof. D. Audits, Inspection and Enforcement. Upon request and with reasonable prior notice by Covered Entity, Business Associate and its agents shall allow Covered Entity to conduct a reasonable inspection of the facilities, systems, books, records, agreements, policies and procedures relating to the use or disclosure of PHI pursuant to this Agreement or for the purpose of determining whether Business Associate is in compliance with its obligations under this Agreement. E. Relationship to Agreements with Covered Entity. In the event that a provision of this Agreement is contrary to a provision of any agreement with Covered Entity pertaining to Business Associate s Services, the provisions of this Agreement shall control. 6

7 F. Relationship of the Parties. FCC and Business Associate are acting solely as independent contractors under this Agreement. It is expressly understood and agreed by the Parties hereto that nothing in this Agreement, its provisions or the relationships contemplated hereby, shall constitute either Party as the general agent, employee, partner, or legal representative of the other Party for any purpose whatsoever, nor shall either Party hold itself out as such. Neither Party to this Agreement shall have the authority to bind or commit the other party hereto in any manner or for any purpose whatsoever, except as may be expressly provided for herein, but rather each Party shall at all times act and conduct itself in all respects and events as an independent contractor. This Agreement creates no relationship of joint venture, partners, associates, or principal and general agent between the Parties hereto. G. Compliance with State and Federal Regulation. Business Associate shall comply with applicable state and federal statutes and regulations governing the privacy, confidentiality and security of patient health information, including but not limited to the requirements established by FCC and the Medicare Advantage program; and shall maintain appropriate policies and procedures to address such requirements and obligations. [Signature Page Follows] 7

8 IN WITNESS WHEREOF, the Parties hereto have executed and delivered this Business Associate Agreement as of the Effective Date. FirstCarolinaCare Insurance Company By: Name: Title: Date: Business Associate By: Name: Title: Date: 8

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

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

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

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

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

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

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

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

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

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 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

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

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (this Agreement ), effective as of May 1, 2014 (the Effective Date ), by and between ( Covered Entity ) and Orchard Software Corporation,

More information

BUSINESS ASSOCIATE AGREEMENT First Choice Community Healthcare, Inc.

BUSINESS ASSOCIATE AGREEMENT First Choice Community Healthcare, Inc. BUSINESS ASSOCIATE AGREEMENT First Choice Community Healthcare, Inc. THIS BUSINESS ASSOCIATE AGREEMENT (BAA) is entered into by and between First Choice Community Healthcare, with a principal place of

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

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

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

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

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

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

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ) by and between OUR LADY OF LOURDES HEALTH CARE SERVICES, INC., hereinafter referred to as Covered Entity, and hereinafter referred

More information

HIPAA Business Associate Addendum

HIPAA Business Associate Addendum HIPAA Business Associate Addendum THIS HIPAA BUSINESS ASSOCIATE ADDENDUM (this Addendum ) is by and between ( Covered Entity ) and TALKSOFT CORPORATION ( Business Associate ) (hereinafter, Covered Entity

More information

EXHIBIT C BUSINESS ASSOCIATE AGREEMENT

EXHIBIT C BUSINESS ASSOCIATE AGREEMENT EXHIBIT C BUSINESS ASSOCIATE AGREEMENT THIS AGREEMENT is made and entered into by and between ( Covered Entity ) and KHIN ( Business Associate ). This Agreement is effective as of, 20 ( Effective Date

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

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

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 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

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

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

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

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

CATHOLIC SOCIAL SERVICES BUSINESS ASSOCIATE AGREEMENT

CATHOLIC SOCIAL SERVICES BUSINESS ASSOCIATE AGREEMENT CATHOLIC SOCIAL SERVICES BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (Agreement) is made this day of, 20, between the Catholic Social Services ( CSS ), whose business address is 3710

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

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

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 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

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 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 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

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

APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT

APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT THIS AGREEMENT is entered into and made effective the day of, 20 (the Effective Date ), by and between (a) THE SOCIETY OF GYNECOLOGIC

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

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Business Associate Agreement (this Agreement ) is entered into as of _September 23_, 2013, (the Effective Date ) by and between Denise T. Nguyen, DDS, PC ( Dental Practice

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

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

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

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

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 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

HIPAA BUSINESS ASSOCIATE SUBCONTRACTOR AGREEMENT

HIPAA BUSINESS ASSOCIATE SUBCONTRACTOR AGREEMENT This HIPAA Sub Business Associate Agreement ("Sub Agreement") is entered into by and between HR Simplified, Inc. ( Business Associate ) and [Vendor Name] on behalf of itself and its Affiliates ( Subcontractor

More information

The Institute of Professional Practice, Inc. Business Associate Agreement

The Institute of Professional Practice, Inc. Business Associate Agreement The Institute of Professional Practice, Inc. Business Associate Agreement This Business Associate Agreement ( Agreement ) effective on (the Effective Date ) is entered into by and between The Institute

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

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

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT 1. The terms and conditions of this document entitled Business Associate Agreement ( Business Associate Agreement ), shall be attached to and incorporated by reference in the

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement and is made between BEST Life and Health Insurance Company ( BEST Life ) and ( Business Associate ). RECITALS WHEREAS, the U.S.

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 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

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( the Agreement ) is entered into this day of, 20 by and between the Tennessee Chapter of the American Academy of Pediatrics ( Business Associate

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

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

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 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

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) BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( BAA ) is by and between the National Association of Boards of Pharmacy

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

BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS

BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS This Business Associate Agreement (this Agreement ), is made as of the day of, 20 (the Effective Date ), by and between ( Business Associate ) and ( Covered Entity

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 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

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

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

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

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT Note: This form is not meant to encompass all the various ways in which any particular facility may use health information and should be specifically tailored to your organization. In addition, as with

More information

STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT

STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT THIS AGREEMENT is entered into and made effective the day of, 2014 (the Effective Date ), by and between (a) GI Quality Improvement Consortuim,

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT COLUMBIA AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) is entered into as of ( Effective Date ) by and between The Trustees of Columbia University in the City of

More information

Sample Business Associate Agreement (4. Other Bus. Assoc., Version 6-06-05)

Sample Business Associate Agreement (4. Other Bus. Assoc., Version 6-06-05) Sample Business Associate Agreement (4. Other Bus. Assoc., Version 6-06-05) This Business Associate Agreement (the Agreement ) is entered into as of, 20, (the Effective Date ) by and between, (the Covered

More information

ACTION COLLECTION SERVICES INC. BUSINESS ASSOCIATE AGREEMENT (FOR MEDICAL PROVIDERS)

ACTION COLLECTION SERVICES INC. BUSINESS ASSOCIATE AGREEMENT (FOR MEDICAL PROVIDERS) ACTION COLLECTION SERVICES INC. BUSINESS ASSOCIATE AGREEMENT (FOR MEDICAL PROVIDERS) THIS BUSINESS ASSOCIATE AGREEMENT (the Agreement ), is dated as of, by and between Action Collection Services Inc. (

More information

HIPAA Business Associate Agreement Instructions

HIPAA Business Associate Agreement Instructions HIPAA Business Associate Agreement Instructions HIPAA AND COLA ACCREDITATION The Health Insurance Portability and Accountability Act (HIPAA) requires laboratories to enter into written agreements with

More information

CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS

CMA BUSINESS ASSOCIATE AGREEMENT WITH CMA MEMBERS 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,

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ), is made effective as of the sign up date on the login information page of the CarePICS.com website, by and between CarePICS,

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

Health Plan Select, Inc. Business Associate Privacy Addendum To The Service Agreement

Health Plan Select, Inc. Business Associate Privacy Addendum To The Service Agreement This (hereinafter referred to as Addendum ) by and between Athens Area Health Plan Select, Inc. (hereinafter referred to as HPS ) a Covered Entity under HIPAA, and INSERT ORG NAME (hereinafter referred

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (this Agreement ) is made effective as of ( Effective Date ) by and between Sentara Health Plans, Inc. ( Covered Entity ) and ( Business Associate

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ), entered into and effective this day of,, is by and between ( Business Associate ) and Black, Gould & Associates, Inc.

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

Enclosure. Dear Vendor,

Enclosure. Dear Vendor, Dear Vendor, As you may be aware, the Omnibus Rule was finalized on January 25, 2013 and took effect on March 26, 2013. Under the Health Insurance Portability & Accountability Act (HIPAA) and the Omnibus

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

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the BAA ) is made and entered into as of the day of, 20, by and between Delta Dental of California (the Covered Entity ) and (the Business

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( Agreement ) is by and between ( Covered Entity ) and Xelex Digital, LLC ( Business Associate ), and is effective as of. WHEREAS,

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

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

COVERMYMEDS BUSINESS ASSOCIATE AGREEMENT

COVERMYMEDS BUSINESS ASSOCIATE AGREEMENT COVERMYMEDS BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (the Agreement ) is entered into between Covered Entity and CoverMyMeds LLC, a Delaware limited liability company ( Business Associate

More information

HIPAA BUSINESS ASSOCIATE ADDENDUM

HIPAA BUSINESS ASSOCIATE ADDENDUM HIPAA BUSINESS ASSOCIATE ADDENDUM This Addendum, dated as of, 2007 ( Addendum ), supplements and is made a part of the Services Agreement (as defined below) by and between ( Covered Entity ) and FUJIFILM

More information

APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT (2012 Version)

APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT (2012 Version) APPENDIX I: STANDARD FORM BUSINESS ASSOCIATE CONTRACT AND DATA USE AGREEMENT (2012 Version) THIS AGREEMENT is entered into and made effective the day of, 2012 (the Effective Date ), by and between (a)

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (the AGREEMENT ) is entered into this (the "Effective Date"), between Delta Dental of Tennessee ( Covered Entity ) and ( Business Associate

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 ( 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

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 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

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

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Business Associate Contract (Agreement) is entered into by and between, as a Covered Entity as defined in relevant federal and state law, and HMS Agency, Inc., as their

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