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Business Associate Agreement THIS BUSINESS ASSOCIATE AGREEMENT (Agreement) is entered into by and between (hereinafter Covered Entity) and EMPLOYER GROUP NAME AGENT/AGENCY NAME (hereafter Business
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How to fill out this business associate agreement

01
Review the Business Associate Agreement template.
02
Fill in the names and contact information of the covered entity and the business associate.
03
Identify the permitted uses and disclosures of protected health information (PHI).
04
Outline the obligations of the business associate to safeguard PHI.
05
Specify the consequences of any breaches of the agreement.
06
Review and discuss the agreement with legal counsel if necessary.
07
Sign and date the agreement.

Who needs this business associate agreement?

01
Healthcare providers
02
Health plans
03
Healthcare clearinghouses
04
Any other entity that performs functions or activities that involve the use or disclosure of protected health information
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This business associate agreement is a contract between a covered entity and a business associate that establishes the permitted and required uses and disclosures of protected health information.
Covered entities and their business associates are required by law to have a business associate agreement in place.
The business associate agreement should be filled out with all relevant information regarding the permitted uses and disclosures of protected health information.
The purpose of this agreement is to ensure that protected health information is properly safeguarded and only used for authorized purposes.
The agreement should include details on how protected health information will be used, disclosed, and safeguarded by the business associate.
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