Business Associate Agreement
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8SAMPLE
BUSINESS ASSOCIATE AGREEMENT
This is a draft business associate agreement based on the template provided by HHS. It is not
intended to be used as is and you should only use the agreement after you have reviewed it with your
legal counsel. O.C.A Benefit Services, LLC does not, nor is it authorized to, provide legal advice, and
the fact that we have provided a sample document should not be construed as such.
Instructions
1.
Fill in the name of your company, the client company’s name and the name of the
applicable group health plan sponsored by the client for which you will be receiving
protected health information where indicated by the red, bracketed text. You will need
this information in:
•
The lead-in paragraph;
•
Section 1.3;
•
Section 1.4; and
•
Above the signature lines.
2.
Fill in the list of purposes for which you may use protected health information shown in
red, bracketed text under Section 3.1(b). If this information is specified in a services
agreement between your company and the client, Section 3.1(a) will govern and a list of
purposes is not required in Section 3.1(b).
3.
The agreement is effective as of the later date signed, so make sure both parties sign
and date the agreement.
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Parent category: Business