Get the free This Business Associate Agreement (Agreement) is entered into as of this

Form No.: OGCS202004BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (Agreement) is entered into as of this day of, 20 between the University of Houston on behalf of (Covered Entity)

How to fill out this business associate agreement

How to fill out this business associate agreement

1. To fill out this business associate agreement, follow the steps below:
2. Begin by entering the full legal name of the covered entity and the business associate at the top of the agreement.
3. Specify the effective date of the agreement.
4. Identify the purpose of the agreement and the services to be provided by the business associate.
5. Define the permitted uses and disclosures of protected health information (PHI) by the business associate.
6. Outline the obligations and responsibilities of the business associate in safeguarding PHI.
7. Specify the term and termination provisions of the agreement.
8. Include any additional provisions or requirements as necessary.
9. Review the agreement for accuracy and completeness.
10. Sign and date the agreement, ensuring all required parties have done so.
11. Keep a copy of the signed agreement for record-keeping purposes.

Who needs this business associate agreement?

1. Any covered entity, such as healthcare providers, health plans, or healthcare clearinghouses, that shares protected health information (PHI) with a business associate needs this business associate agreement.
2. Additionally, any business associate that performs services on behalf of a covered entity and requires access to PHI needs to have this agreement in place.
3. It is a requirement under the Health Insurance Portability and Accountability Act (HIPAA) for ensuring the protection of PHI and defining the responsibilities of both parties.

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What is this business associate agreement?

This business associate agreement is a contract between a covered entity and a business associate to ensure the protection of PHI.

Who is required to file this business associate agreement?

Covered entities are required to file this business associate agreement.

How to fill out this business associate agreement?

The business associate agreement can be filled out by specifying the parties involved, outlining the obligations of the business associate, and including any necessary provisions to protect PHI.

What is the purpose of this business associate agreement?

The purpose of this business associate agreement is to establish the responsibilities of the business associate in safeguarding protected health information (PHI).

What information must be reported on this business associate agreement?

The business associate agreement must include the names of the covered entity and business associate, the obligations of the business associate regarding PHI, and any additional provisions for compliance with HIPAA.