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NOTICE OF PRIVACY PRACTICES of the UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM AFFILIATED COVERED ENTITY, ORGANIZED HEALTH CARE ARRANGEMENT, AND OTHER AFFILIATES THIS NOTICE DESCRIBES HOW MEDICAL

How to fill out affiliated covered entity organized

How to fill out affiliated covered entity organized:

1. Identify the purpose: Determine why you need to fill out the affiliated covered entity organized form. This could be because your organization is a healthcare provider or a business associate that handles protected health information (PHI).
2. Gather necessary information: Collect all the required details such as the legal name and contact information of the organization, its tax identification number (TIN), and any affiliated entities or subcontractors.
3. Review the instructions: Familiarize yourself with the instructions provided with the form. It will outline the specific requirements for each section and provide guidance on how to complete them accurately.
4. Complete Section I: Provide the basic details of the affiliated covered entity, including its legal name, TIN, address, and contact information. Also, indicate the type of affiliated covered entity it is (e.g., healthcare provider, business associate).
5. Complete Section II: Specify whether the affiliated covered entity is part of a larger organization or a standalone entity. If it is part of a larger organization, provide details about the parent organization, including its legal name and TIN.
6. Complete Section III: If the affiliated covered entity has any subcontractors or affiliated entities that are also part of the organized healthcare arrangement, list their details in this section. Include their legal names, TINs, and addresses.
7. Review and sign: Double-check all the information you have entered to ensure accuracy. Sign and date the form to certify that the information provided is correct to the best of your knowledge.

Who needs affiliated covered entity organized:

1. Healthcare providers: Organizations that provide medical services, such as hospitals, clinics, doctors' offices, and pharmacies, may need to fill out the affiliated covered entity organized form if they are part of a larger healthcare network or organization.
2. Business associates: Companies that handle or have access to PHI on behalf of a healthcare provider, such as billing companies, IT service providers, and transcription services, may also need to complete the affiliated covered entity organized form.
3. Organizations involved in organized healthcare arrangements: Any entity that participates in an organized healthcare arrangement, where two or more entities collaborate to provide healthcare services, will likely need to fill out the affiliated covered entity organized form. This includes entities that contract with a healthcare provider to provide services to their patients or entities that share PHI within a network to coordinate patient care.

For pdfFiller’s FAQs

What is affiliated covered entity organized?

An affiliated covered entity is organized as a single legal entity that includes multiple healthcare provider components.

Who is required to file affiliated covered entity organized?

The affiliated covered entity must file if it meets the criteria outlined by HIPAA regulations.

How to fill out affiliated covered entity organized?

The affiliated covered entity organized form can be filled out electronically or manually, following the provided instructions by HIPAA regulations.

What is the purpose of affiliated covered entity organized?

The purpose of the affiliated covered entity organized form is to provide a comprehensive overview of the healthcare provider components within the entity.

What information must be reported on affiliated covered entity organized?

Information such as the name, address, and NPI of each healthcare provider component must be reported on the affiliated covered entity organized form.

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