sample business associate agreement

a business associate is directly liable under the hipaa rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of protected health information that are not authorized by its contract or required by law. (f) make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 cfr 164.526, or take other measures as necessary to satisfy covered entity’s obligations under 45 cfr 164.526; [the parties may wish to add additional specificity regarding how the business associate will respond to a request for amendment that the business associate receives directly from the individual (such as whether and in what time and manner a business associate is to act on the request for amendment or whether the business associate will forward the individual’s request to the covered entity) and the timeframe for the business associate to incorporate any amendments to the information in the designated record set.]







(c) [optional] covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 cfr 164.522, to the extent that such restriction may affect business associate’s use or disclosure of protected health information. [option 1 – if the business associate is to return or destroy all protected health information upon termination of the agreement] upon termination of this agreement for any reason, business associate shall return to covered entity [or, if agreed to by covered entity, destroy] all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form.

after a baa terminates, all patient health information is required to be returned to the covered entity or destroyed by the business associate (45 cfr 164.504(e)(2)(ii)(j)). a business associate is an independent contractor that is authorized to access a covered entity‘s medical records (45 cfr § 160.103). the name of the covered entity (i.e. if the covered entity is a different type of entity the third checkbox (“other”) must be marked and the classification of the covered entity’s organization should be documented.

the type of entity the business associate operates requires definition to further identify this party. the covered entity’s daytime business phone number must be supplied to this document along with its official email address. the covered entity that is participating in this agreement must deliver a signature to enter it. therefore, the business associate must elect a signature party to sign his or her name and deliver the current date. once the signature party has identified the name of the business associate he or she represents, the title of his or her office with the business associate should be documented.

this document includes sample business associate agreement provisions to help covered entities and business associates more easily comply with this business associate agreement (the “baa”) is made and entered into as of by and between. , a organized under the laws of the. (“covered entity”) and. this business associate agreement (the “agreement”) is entered into as of. ,. 201_, (the “effective date”) by and between. , (the “covered entity”) and. , (the, business associate agreement template word, business associate agreement template word, business associate agreement template 2022, free business associate agreement template, business associate agreement hipaa.

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