BREVIUM HIPAA BUSINESS ASSOCIATE TERMS AND CONDITIONS

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "BREVIUM HIPAA BUSINESS ASSOCIATE TERMS AND CONDITIONS"

Transcription

1 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 and Consulting Agreement to which it this Exhibit B is attached, and capitalized terms not otherwise defined herein have the meanings set forth in the Agreement. By signing the Agreement the Customer and Brevium also agree to these terms Pursuant to the Agreement, Brevium, its employees, subcontractors, agents and affiliates, if any (individually and collectively, the Business Associate ) performs functions or activities on behalf of Customer involving the use and/or disclosure of PHI. Business Associate, therefore, agrees to the following terms and conditions set forth in this HIPAA Agreement. 1. Definitions. For purposes of this HIPAA Agreement, the following terms shall have the designated meanings. All other terms shall have the same meanings as in HIPAA or HITECH. (a) "Administrative Safeguards" shall mean administrative actions, policies and procedures to manage the selection, development, implementation and maintenance of security measures to protect Electronic PHI and to manage the conduct of the Business Associate's workforce in relation to the protection of that information. (b) "Breach" shall have the same meaning as provided in 45 C.F.R "Designated Record Set" shall have the same meaning provided in 45 C.F.R (a). (d) "Electronic PHI" shall have the same meaning provided in 45 C.F.R (e) (f) (g) (h) "HIPAA" shall mean the Health Insurance Portability and Accountability Act of 1996, and any amendments thereto. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164. "HITECH" shall mean the Health Information Technology for Economic and Clinical Health Act, which is Title XIII of the American Recovery and Reinvestment Act, and any amendments, regulations, rules and guidance issued thereto and the relevant dates for compliance. "Individually Identifiable Health Information" shall mean information that is a subset of health information, including genetic and demographic information collected from an individual, and i. is created or received by a healthcare provider, health plan, employer, or healthcare clearinghouse; and ii. relates to the past, present, or future physical or mental health or condition of an individual; the provision of healthcare to an individual; or the past, present, or future payment for the provision of healthcare to an individual; and (i) identifies the individual, or (ii) with respect to which there is a reasonable basis to believe the information can be used to identify the individual. (i) (j) "Physical Safeguards" shall mean physical measures, policies and procedures to protect Business Associate's electronic information systems and related buildings and equipment from natural and environmental hazards and unauthorized intrusion. "Privacy Standards" shall mean the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Parts 160 and 164.

2 (k) "Protected Health Information" or "PHI" shall have the meaning provided in 45 C.F.R , limited to the information created or received by the Business Associate from or on behalf of the Customer. (l) "Secretary" shall mean the Secretary of the United States Department of Health and Human Services. (m) "Security Incident shall have the same meaning provided in 45 C.F.R (n) (o) (p) (q) "Security Standards" shall mean the regulations with regard to security standards for health information, 45 C.F.R. Parts 160 and 164. "Technical Safeguards" shall mean the technology, and the policy and procedures for its use, which protects Electronic PHI and controls access to it. "Transaction Standards" shall mean the Standards for Electronic Transactions, 45 C.F.R. Parts 160 and 162. "Unsecured PHI" 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 under section 13402(h)(2) of Public Law Compliance with Applicable Law. The parties acknowledge and agree that as of the Effective Date, Business Associate shall comply with its obligations under this HIPAA Agreement and with all obligations of a business associate under HIPAA, HITECH and other related laws and any implementing regulations, as they exist at the time this HIPAA Agreement is executed and as they are amended. Without limiting the foregoing, Business Associate agrees it will comply with all applicable state laws not preempted by HIPAA or HITECH. 3. Uses and Disclosures of PHI. Business Associate shall not, and shall ensure that its directors, officers, employees, and agents do not, use or disclose PHI received from Customer in any manner that is not permitted or required by the Agreement or required/permitted by law. All uses and disclosures of and requests by Business Associate for PHI are subject to the minimum necessary rule of the Privacy Standards and shall be limited to the information contained in a limited data set, to the extent practical, unless additional information is needed to accomplish the intended purpose, or as otherwise permitted in accordance with Section 13405(b) of HITECH and any implementing regulations. Business Associate may disclose PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided: (a) the disclosures are required or permitted by law; or (b) Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required/permitted by law or for the purposes for which it was disclosed to the person, and the person notifies Business Associate of any instances in which it is aware in which the confidentiality of the information has been breached. 4. Required Safeguards To Protect PHI. Business Associate agrees that it will implement any and all necessary Administrative Safeguards, Physical Safeguards, Technical Safeguards or other safeguards, policies and procedures in accordance with the Privacy Standards, Security Standards and Transaction Standards, including but, not limited to Subpart C of 45 C.F.R. Part 164, to prevent the use or disclosure of PHI other than pursuant to the terms and conditions of the Agreement or as required/permitted by law. 5. Notification in Case of Breach. In the event of an impermissible acquisition, access, use or disclosure of Unsecured PHI created or maintained by Business Associate, Business Associate shall determine if a Breach has occurred.

3 (a) If Business Associate determines that a Breach of Unsecured PHI created or maintained by Business Associate has occurred, Business Associate shall notify Customer of such Breach, in accordance with Section of HITECH and 45 C.F.R , without unreasonable delay and, in no case later than twenty (20) calendar days after discovery of the Breach. Discovery of a Breach by Business Associate shall be deemed to have occurred as of the first day on which such a Breach is known to Business Associate or, by exercising reasonable diligence, would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a Breach if the Breach is known, or, by exercising reasonable diligence would have been known, to any person, other than the person committing the Breach, who is a workforce member or agent of Business Associate. Such notice ( Breach Notice ) shall include, to the extent known by Business Associate, the following: 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 such Breach; ii) a description of the nature of the unauthorized acquisition, access, use or disclosure, including the date of the Breach and the date of discovery of the Breach; iii) a description of the type Unsecured PHI acquired, accessed, used or disclosed in the Breach (e.g. full name, social security number, date of birth, home address, account number or disability code); iv) a description of what Business Associate is doing to investigate the Breach, to mitigate losses and to protect against any further Breaches; and v) the contact information for Business Associate s representative(s) who are knowledgeable of the Breach. 6. Agreements by Third Parties. In accordance with 45 C.F.R (e)(1)(ii) and (b)(2), Business Associate shall enter into an agreement with any agent or subcontractor of Business Associate that will have access to PHI that is received from, or is created or received by, Business Associate on behalf of Customer. Pursuant to such agreement, the agent or subcontractor shall agree to be bound by the same restrictions, terms, and conditions that apply to Business Associate under this HIPAA Agreement with respect to such PHI. 7. Access to Information. Within twenty (20) calendar days of a request by Customer for access to PHI about an individual contained in a Designated Record Set, Business Associate shall make available to Customer such PHI for so long as such information is maintained by Business Associate in the Designated Record Set, as required by 45 C.F.R In the event any individual delivers directly to Business Associate a request for access to PHI, Business Associate shall within ten (10) calendar days forward such request to Customer. 8. Availability of PHI for Amendment. Within twenty (20) calander days of receipt of a request from Customer for the amendment of an individual's PHI or a record regarding an individual contained in a Designated Record Set (for so long as the PHI is maintained in the Designated Record Set), Business Associate shall provide such information to Customer for amendment and incorporate any such amendments in the PHI as required by 45 C.F.R Documentation of Disclosures. Business Associate agrees to document all disclosures of PHI and information related to such disclosures as would be required for Customer to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 C.F.R At a minimum, Business Associate shall provide Customer with the following information: (i) the date of the disclosure; (ii) the name of the entity or person who received the PHI, and if known, the address of

4 such entity or person; (iii) a brief description of the PHI disclosed; and (iv) a brief statement of the purpose of such disclosure which includes an explanation of the basis for such disclosure. 10. Accounting of Disclosures. Within twenty (20) calendar days of notice by Customer to Business Associate that it has received a request for an accounting of disclosures of PHI regarding an individual during the six (6) years prior to the date on which the accounting was requested, Business Associate shall make available to Customer information collected in accordance with this HIPAA Agreement, to permit Customer to respond to the request for an accounting of disclosures of PHI, as required by 45 C.F.R In the case of an electronic health record maintained or hosted by Business Associate on behalf of Customer, the accounting period shall be three (3) years and the accounting shall include disclosures for treatment, payment and healthcare operations, in accordance with the applicable effective date of Section 13402(a) of HITECH. In the event the request for an accounting is delivered directly to Business Associate, Business Associate shall within ten (10) calendar days forward such request to Customer. Business Associate hereby agrees to implement an appropriate record keeping process to enable it to comply with the requirements of this Section. 11. Availability of Books and Records. Business Associate hereby agrees to make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of, Customer available to the Secretary for purposes of determining Customer's compliance with the HIPAA Rules. 12. Electronic PHI. To the extent that Business Associate creates, receives, maintains or transmits Electronic PHI on behalf of Customer, Business Associate shall comply with the Security Standards as of the relevant effective date and further, shall: (a) Implement Administrative, Physical and Technical Safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the Electronic PHI, in accordance with Section 13401(a) of HITECH; (b) Ensure that any agent, including a Business Associate, to whom it provides Electronic PHI agrees to implement reasonable and appropriate safeguards to protect it; and Report to Customer any Security Incident of which Business Associate becomes aware. 13. Termination for Cause. In addition to any other rights Customer may have in the Agreement, Business Associate authorizes the termination of the Agreement by Customer, if Customer determines Business Associate has violated a material term of this HIPAA Agreement and Business Associate has not cured such breach or ended the violation within thirty (30) calendar days written notice from the Customer to the Business Associate. 14. Effect of Termination. Upon the termination of the Agreement for any reason, Business Associate, with respect to PHI received from Customer, or created, maintained, or received by Business Associate on behalf of Customer, shall: (a) (b) Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; Return to Customer or destroy the remaining PHI that the Business Associate still maintains in any form; Continue to use appropriate safeguards and comply with Subpart C of 45 C.F.R. Part 164 with respect to electronic PHI to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as Business Associate retains the PHI;

5 (d) (e) Not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out in Section 3 of this HIPAA Agreement which applied prior to termination; and Return to Customer or destroy the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities. The obligations of Business Associate under this Section shall survive termination of the Agreement. 15. Changes in the Law. Customer may amend either the Agreement (including this HIPAA Agreement) to conform to any new or revised legislation, rules and regulations to which Customer is subject now or in the future including, without limitation, HIPAA, HITECH, the Privacy Standards, Security Standards or Transactions Standards.

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 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 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

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

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

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 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

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

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 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

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

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

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

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

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 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

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

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

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

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

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

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 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

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

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 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

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

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 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 POLICY REGARDING BUSINESS ASSOCIATES

HIPAA POLICY REGARDING BUSINESS ASSOCIATES HIPAA POLICY REGARDING BUSINESS ASSOCIATES SCOPE OF POLICY: What Units Are Covered by this Policy?: This policy applies to the following units of Emory University: School of Medicine; School of Nursing;

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

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. 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

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

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 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

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

More information

HIPAA BUSINESS ASSOCIATE AGREEMENT

HIPAA BUSINESS ASSOCIATE AGREEMENT HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( Agreement ) is entered into as of the day of, 2013 by and between RUTGERS UNIVERSITY, a Hybrid Entity, on behalf and for the

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

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

Definitions. Catch-all definition:

Definitions. Catch-all definition: BUSINESS ASSOCIATE AGREEMENT THESE PROVISIONS MAY STAND ALONE AS A BUSINESS ASSOCIATE AGREEMENT, OR MAY BE INCORPORATED INTO A LARGER, MORE COMPREHENSIVE CONTRACT WITH THE BUSINESS ASSOCIATE TO COVER OTHER

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

BUSINESS ASSOCIATE AGREEMENT TERMS

BUSINESS ASSOCIATE AGREEMENT TERMS BUSINESS ASSOCIATE AGREEMENT TERMS This Addendum ( Addendum ) is incorporated into and made part of the Agreement between SIGNATURE HEALTHCARE CORPORATION ("Covered Entity ) and ( Business Associate"),

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

Appendix : Business Associate Agreement

Appendix : Business Associate Agreement I. Authority: Pursuant to 45 C.F.R. 164.502(e), the Indian Health Service (IHS), as a covered entity, is required to enter into an agreement with a business associate, as defined by 45 C.F.R. 160.103,

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

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

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

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

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

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

Terms and Conditions Relating to Protected Health Information ( City PHI Terms ) Revised and Effective as of September 23, 2013

Terms and Conditions Relating to Protected Health Information ( City PHI Terms ) Revised and Effective as of September 23, 2013 Terms and Conditions Relating to Protected Health Information ( City PHI Terms ) Revised and Effective as of September 23, 2013 The City of Philadelphia is a Covered Entity as defined in the regulations

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

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

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 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. Emory University and/or Emory Healthcare, Inc. ( Emory ) ( Covered Entity ) and

BUSINESS ASSOCIATE AGREEMENT. Emory University and/or Emory Healthcare, Inc. ( Emory ) ( Covered Entity ) and BUSINESS ASSOCIATE AGREEMENT Emory University and/or Emory Healthcare, Inc. ( Emory ) ( Covered Entity ) and Associate ) ( Business This Business Associate Agreement (this Agreement ) effective as of (the

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 entered between ("Covered Entity" or "CE") and, ("Business Associate" or "BA"), collectively the Parties, who agree as follows:

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 HIPAA Protected Health Information

BUSINESS ASSOCIATE AGREEMENT HIPAA Protected Health Information BUSINESS ASSOCIATE AGREEMENT HIPAA Protected Health Information I. PREAMBLE ( Covered Entity ) and ( Business Associate ) (jointly the Parties ) wish to enter into an Agreement to comply with the requirements

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

Use & Disclosure of Protected Health Information by Business Associates

Use & Disclosure of Protected Health Information by Business Associates Applicability: Policy Title: Policy Number: Use & Disclosure of Protected Health Information by Business Associates PP-12 Superseded Policy(ies) or Entity Policy: N/A Date Established: January 31, 2003

More information

Check In Systems. Software Usage Agreement

Check In Systems. Software Usage Agreement Check In Systems Software Usage Agreement Usage of Check In Systems Inc. software shall constitute agreement with the following; You understand that you have the right to terminate or not use the software

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 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

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

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

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 BETWEEN LEWIS & CLARK COLLEGE AND ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. I. PREAMBLE

BUSINESS ASSOCIATE AGREEMENT BETWEEN LEWIS & CLARK COLLEGE AND ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. I. PREAMBLE BUSINESS ASSOCIATE AGREEMENT BETWEEN LEWIS & CLARK COLLEGE AND ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. I. PREAMBLE Lewis & Clark College and Allegiance Benefit Plan Management, Inc., (jointly the Parties

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

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

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT BUSINESS ASSOCIATE TERMS AND CONDITIONS

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT BUSINESS ASSOCIATE TERMS AND CONDITIONS COVERYS RRG, INC. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT BUSINESS ASSOCIATE TERMS AND CONDITIONS WHEREAS, the Administrative Simplification section of the Health Insurance Portability and

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

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 Business Associate Agreement

HIPAA Privacy and Business Associate Agreement HR 2011-07 ATTACHMENT D HIPAA Privacy and Business Associate Agreement This Agreement is entered into this day of,, between [Employer] ( Employer ), acting on behalf of [Name of covered entity/plan(s)

More information

BREACH NOTIFICATION POLICY

BREACH NOTIFICATION POLICY PRIVACY 2.0 BREACH NOTIFICATION POLICY Scope: All subsidiaries of Universal Health Services, Inc., including facilities and UHS of Delaware Inc. (collectively, UHS ), including UHS covered entities ( Facilities

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

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

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

More information

BUSINESS ASSOCIATE CONTRACTUAL ADDENDUM

BUSINESS ASSOCIATE CONTRACTUAL ADDENDUM BUSINESS ASSOCIATE CONTRACTUAL ADDENDUM This HIPAA Addendum ("Addendum") is entered into effective this first day of November 1, 2015, by and between "Business Associate" AND COUNTY OF OTTAWA Ottawa County

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

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

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 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 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

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 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 PRIVACY AND SECURITY ADDENDUM RECITALS

BUSINESS ASSOCIATE PRIVACY AND SECURITY ADDENDUM RECITALS BUSINESS ASSOCIATE PRIVACY AND SECURITY ADDENDUM This Business Associate Addendum ( Addendum ), effective, 20 ( Effective Date ), is entered into by and between University of Southern California, ( University

More information

STANDARD ADMINISTRATIVE PROCEDURE

STANDARD ADMINISTRATIVE PROCEDURE STANDARD ADMINISTRATIVE PROCEDURE 16.99.99.M0.26 Investigation and Response to Breach of Unsecured Protected Health Information (HITECH) Approved October 27, 2014 Next scheduled review: October 27, 2019

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