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Business Associate Agreement

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BUSINESS ASSOCIATE AGREEMENT

This Business Associate Agreement (the “Agreement”) is effective as of

(the “Agreement Effective Date”) by and between

(“CE”) and

(“BA”).

RECITALS

WHEREAS, CE has engaged BA to perform services or provide goods, or both;

WHEREAS, CE possesses Individually Identifiable Health Information that is protected

under HIPAA (as hereinafter defined) and the HIPAA Regulations (as hereinafter defined), and

is permitted to use or disclose such information only in accordance with HIPAA and the HIPAA

Regulations;

WHEREAS, BA may receive such information from CE, or create and receive such

information on behalf of CE, in order to perform certain of the services or provide certain of the

goods, or both; and

WHEREAS, CE wishes to ensure that BA will appropriately safeguard Individually

Identifiable Health Information;

NOW THEREFORE, CE and BA agree as follows:

Definitions. The parties agree that the following terms, when used in this Agreement,

shall have the following meanings, provided that the terms set forth below shall be deemed to be

modified to reflect any changes made to such terms from time to time as defined in HIPAA and

the HIPAA Regulations.

a. “Business Associate” means, with respect to a Covered Entity, a person who:

(1) on behalf of such Covered Entity or of an organized health care arrangement

(as defined under the HIPAA Regulations) in which Covered Entity participates,

but other than in the capacity of a member of the workforce of such Covered

Entity or arrangement, performs, or assists in the performance of:

a) a function or activity involving the use or disclosure of Individually

Identifiable Health Information, including claims processing or

administration, data analysis, processing or administration, utilization

review, quality assurance, billing, benefit management, practice

management, and repricing; or

b) any other function or activity regulated by the HIPAA Regulations; or

9100767.3

Business Associate Agreement

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