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BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (Agreement) is entered into by and between NAME OF BA and its affiliated entities (Business Associate) and Children's Hospital and Health

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How to fill out this business associate agreement

01

To fill out this business associate agreement, follow these steps:

02

Start by entering the full legal names of both the covered entity and the business associate.

03

State the effective date of the agreement and specify the duration of the agreement.

04

Describe the permitted uses and disclosures of protected health information (PHI) by the business associate.

05

Identify the responsibilities of the business associate regarding PHI security and privacy safeguards.

06

Include provisions for breach notification and specify the timeframe within which the business associate must report any breaches.

07

Outline the termination conditions and procedures for the agreement.

08

Indicate the dispute resolution process in case of any disagreements.

09

Both parties must sign and date the agreement to make it legally binding.

10

Retain a copy of the fully executed agreement for future reference and compliance purposes.

Who needs this business associate agreement?

01

Any covered entity, as defined by the Health Insurance Portability and Accountability Act (HIPAA), who discloses protected health information (PHI) to a business associate needs this business associate agreement.

02

Examples of entities that may need this agreement include:

03

- Healthcare providers who outsource certain functions to external service providers (e.g., billing companies, IT support)

04

- Health plans that share PHI with third-party administrators or utilization review companies

05

- Pharmacies that utilize prescription fulfillment services

06

- Any other entity that handles PHI on behalf of a covered entity

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What is this business associate agreement?

A business associate agreement is a contract between a covered entity and a business associate that establishes the terms and conditions regarding the use and disclosure of protected health information.

Who is required to file this business associate agreement?

Covered entities are required to file a business associate agreement with their business associates.

How to fill out this business associate agreement?

The business associate agreement should be filled out by including specific terms and conditions related to the protection of PHI, compliance with HIPAA regulations, and obligations of both parties.

What is the purpose of this business associate agreement?

The purpose of the business associate agreement is to ensure that the business associate complies with HIPAA regulations and safeguards the protected health information shared with them.

What information must be reported on this business associate agreement?

The business associate agreement should include details about the permitted uses and disclosures of PHI, obligations regarding safeguarding PHI, and compliance with HIPAA requirements.

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