hipaa associate agreement

8/13/2019 Hipaa Associate Agreement

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BUSINESS ASSOCIATE AGREEMENT

Organization name here!

This Agreement is entered into by and between (Health Care Provider) and Bui!e

Ao"iate to set forth the terms and conditions under which protected health information (PHI),

as defined by the Health Insurance Portability and Accountability Act of !!" (HIPAA) and#egulations enacted hereunder, created or recei$ed by (%usiness Associate) on behalf of

(Health Care Provider) may be used or disclosed&

This Agreement shall commence on (#ate) and the obligations herein shall continue in effect so

long as Bui!e Ao"iate uses, discloses, creates or otherwise possesses any protected health

information created or recei$ed on behalf of (Health Care Provider) and until all protected

health information created or recei$ed by Bui!e Ao"iate on behalf of (Health Care

Provider) is destroyed or returned to (Health Care Provider)pursuant to Paragraph '

herein&

) (Health Care Provider) and Bui!e Ao"iate hereby agree that Bui!e

Ao"iate shall be permitted to use andor disclose protected health information createdor recei$ed on behalf of (Health Care Provider) for the following purposes

a) *ompleting and submitting health care claims to health plans, *learinghouses,

and other third party payers&

b) *ollection of fees for (Health Care Provider)&c) +stablishing and maintaining %usiness anagement Programs for (Health

Care Provider)$

d) Introducing, maintaining, and programming +lectronic edical #ecord -ystems

for (Health Care Provider)$e) Introducing, maintaining, and programming compatible .ictation -ystems for

(Health Care Provider)$

It is to be understood by all parties that the permitted uses and disclosures must by within thescope of and necessary to achie$e, the obligations and responsibilities of Bui!e Ao"iate in

performing on behalf of, or pro$iding ser$ices to, the Health *are Pro$ider&

/) Bui!e Ao"iate may use and disclose protected health information created or

recei$ed by Bui!e Ao"iate on behalf of (Health Care Provider)if necessary for

the proper management and administration of Bui!e Ao"iateor to carry out& legal

responsibilities, pro$ided that any disclosure is

a) #e0uired by law, or

b) Bui!e Ao"iateobtains reasonable assurances from the person to whom the

protected health information is disclosed that (i) the protected health informationwill be held confidentially and used or further disclosed only as re0uired by law

or for the purpose for which it was disclosed to the person1 and (ii) Bui!eAo"iatewill be notified of any instances of which the person is aware in which

the confidentiality of the information is breached&

2) %usiness Associate hereby agrees to maintain the security and pri$acy of all protected

health information in a manner consistent with *alifornia -tate and 3ederal laws and

regulations, including the Health insurance Portability and Accountability Act of !!"

(HIPAA) and regulations hereunder, and all other applicable law&


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4) Bui!e Ao"iatefurther agrees not to use or disclose protected health information

e5cept as e5pressly permitted by this Agreement, applicable law, or for the purpose of

managing %usiness Associate own internal business processes consistent with Paragraph

/ herein&

') Bui!e Ao"iate shall not disclose protected health information to any member of its

wor6force unless Bui!e Ao"iatehas ad$ised such person (employee) of Bui!eAo"iatepri$acy and security obligations and policies under this Agreement, including

the conse0uences for $iolation of such obligations& %usiness Associate shall ta6e

appropriate disciplinary action against any member of its wor6force who uses or

discloses protected health information in $iolations of this Agreement and applicable law&

") Bui!e Ao"iate shall not disclose protected health information created or recei$ed by

%usiness Associate on behalf of (Health Care Provider)to a person, including any

agent or subcontractor of Bui!e Ao"iatebut not including a member of Pri%e

Cli!i"al S&te%$ I!"$'own wor6force, until such person agrees in writing to be bound

by the pro$isions of the Agreement and applicable *alifornia -tate or 3ederal law&

7) Bui!e Ao"iateagrees to use appropriate safeguards to pre$ent use ordisclosure of protected health information not permitted by this Agreement or

applicable law&

8) Bui!e Ao"iateagrees to maintain a record of all disclosures of protected

health information, including disclosures not made for the purposes of thisAgreement& -uch record shall include the date of the disclosure, the name and, if

6nown, the address of the recipient of the protected health information, the name

of the indi$idual who is the sub9ect of the protected health information, a briefdescription of the protected health information disclosed, and the purpose of the

disclosure& Bui!e Ao"iateshall ma6e such record a$ailable to an indi$idual

who is the sub9ect of such information or (Health Care Provider)within fi$e(') wor6ing days of a re0uest and shall include disclosures made on or after the

date which is si5 (") years prior to the re0uest or April 4, /::2, whiche$er date is

later&

!) Bui!e Ao"iate agrees to report to (Health Care Provider)any unauthori;ed use

or disclosure of protected health information by %usiness Associate or its wor6force or

subcontractors and the remedial action ta6en or proposed to be ta6en with respect to such

use or disclosure&

:) Bui!e Ao"iate agrees to ma6e its internal practices, boo6s, and records relating to

the use and disclosure of protected health information recei$ed from (HealthCare

Provider)or created or recei$ed by Bui!e Ao"iateon behalf of (Health CareProvider), a$ailable to the -ecretary of the ithin thirty (2:) days of a written re0uest by (Health Care Provider), Bui!e

Ao"iateshall allow a person who is the sub9ect of protected health information, such

person=s legal representati$e, or (Health Care Provider)to ha$e access to and to copy


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such person=s protected health information in the format re0uested by such person, legal

representati$e, or practitioner unless it is not readily producible in such format, in which

case it shall be produced in standard hard copy format&

/) Bui!e Ao"iateagrees to amend, pursuant to a re0uest by (Health Care

Provider), protected health information maintained and created or recei$ed by Bui!e

Ao"iate, on behalf of the Practitioner& Bui!e Ao"iatefurther agrees to completesuch amendment within thirty (2:) days of a written re0uest by (Health Care

Provider)and to ma6e such amendment as directed by (Health CareProvider)&

2) In the e$ent Bui!e Ao"iatefails to perform the obligations under this Agreement,

(Health *are Pro$ider) may, at its option

a) #e0uire Bui!e Ao"iateto submit to a plan of compliance, including

monitoring by (Health Care Provider)and reporting by %usiness Associate,

as (Health Care Provider)in its sole discretion, determines necessary to

maintain compliance with this Agreement and applicable law& -uch plan shall be

incorporated into this Agreement by amendment hereto and

b) #e0uire Bui!e Ao"iateto mitigate any loss occasioned by the unauthori;eddisclosure or use of protected health information&

c) Immediately discontinue pro$iding protected health information to Bui!e

Ao"iatewith or without written notice to Bui!e Ao"iate

4) (Health Care Provider) may immediately terminate this Agreement and related

agreements if (Health Care Provider) determines that Bui!e Ao"iate has

breached a material term of this Agreement& Alternati$ely, (Health Care Provider)

may choose to (i) pro$ide Bui!e Ao"iate with ten (:) days written notice of the

e5istence of an alleged material breach1 and (ii) afford Bui!e Ao"iate an opportunity

to cure said alleged material breach to the satisfaction of (Health Care Provider)

within (:) days& Bui!e Ao"iate' failure to cure shall be grounds for immediate

termination of this agreement& (Health Care Provider)' remedies under thisAgreement are cumulati$e, and the

e5ercise of any remedy shall not preclude the e5ercise of any other&

')


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Bui!e Ao"iatemay elect to discontinue the Agreement within the ten (:) day

period, but Bui!e Ao"iateduties hereunder to maintain the security and pri$acy of

P#?T+*T+. H+A@TH I3?#ATI? shall sur$i$e such discontinuance& (Health

Care Provider) and Bui!e Ao"iate may otherwise amend this Agreement by

mutual written agreement&

7) Bui!e Ao"iate shall, to the fullest e5tent permitted by law, protect, defend,indemnify and hold harmless (Health Care Provider) and hisher respecti$e

employees, directors, and agents (Indemnities) from and against any and all losses,

costs, claims, penalties, fines, demands, liabilities, legal actions, 9udgments, and e5penses

of e$ery 6ind (including reasonable attorneys fees, including at trial and on appeal)

asserted or imposed against any Indemnities arising out of the acts or omissions of

Bui!e Ao"iate or any of Bui!e Ao"iate'employees, directors, or agents

related to the performance or nonperformance of this Agreement&

(Health Care Provider) #ate

Bui!e Ao"iate #ate

hipaa associate agreement

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