Provider Service & HIPAA Business Associate Agreement
This Provider Service & HIPAA Business Associate Agreement (“Agreement”) is entered into as of [Effective Date], by and between:
Tabendi Healthcare Network, with a principal place of business at 715 W. Lake Street, Suite 201, Addison, IL, 60101 (“Business Associate” or “THN”), and, the Provider (“Covered Entity” or “Provider”).
THN and Provider may be collectively referred to as the “Parties” and individually as a “Party.”
1. Purpose and Scope
1.1 Purpose – This Agreement sets forth the terms and conditions under which THN will provide technology-enabled healthcare connection and administrative services (“Services”) to Provider, and the terms under which THN will handle Protected Health Information (“PHI”) on Provider’s behalf, in compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the HITECH Act, and their implementing regulations.
1.2 Nature of Relationship – Provider is a HIPAA “Covered Entity” and THN is a HIPAA “Business Associate” as those terms are defined in 45 C.F.R. §160.103.
2. Service Terms
2.1 Services Provided – THN shall provide a technology platform to facilitate patient-provider connections, appointment scheduling, telehealth, messaging, and administrative support.
2.2 Provider Responsibilities – Provider agrees to:
2.3 Fees and Payment – Provider shall pay THN according to the pricing schedule in Exhibit A. Payment is due as specified in the service invoice terms.
2.4 Service Availability – THN will use commercially reasonable efforts to maintain availability of the Services but does not guarantee uninterrupted access.
3. HIPAA Business Associate Obligations
THN agrees to:
3.1 Use and Disclosure – Use or disclose PHI only as permitted by this Agreement or as Required by Law.
3.2 Safeguards – Implement administrative, physical, and technical safeguards in accordance with 45 C.F.R. §§164.308, 164.310, and 164.312 to protect PHI.
3.3 Minimum Necessary – Limit the use, disclosure, and request of PHI to the minimum necessary.
3.4 Reporting – Report to Provider within five (5) business days any use or disclosure of PHI not permitted by this Agreement, including breaches of Unsecured PHI and any Security Incidents.
3.5 Mitigation – Mitigate any harmful effects of an improper PHI use or disclosure to the extent practicable.
3.6 Subcontractors – Ensure any subcontractors with access to PHI agree in writing to comply with the same restrictions and safeguards.
3.7 Access and Amendments – Provide access to PHI in a Designated Record Set and make amendments as directed by Provider in accordance with 45 C.F.R. §§164.524 and 164.526.
3.8 Accounting of Disclosures – Maintain records and provide an accounting of disclosures in accordance with 45 C.F.R. §164.528.
3.9 HHS Access – Make internal practices, books, and records related to PHI available to the Secretary of Health and Human Services for HIPAA compliance review.
4. Permitted Uses and Disclosures by THN
THN may:
5. Term and Termination
5.1 Term – This Agreement remains in effect until terminated in writing by either Party.
5.2 Termination for Cause – Upon material breach, the non-breaching Party may terminate if breach is not cured within 30 days of notice.
5.3 Effect of Termination – Upon termination, THN will return or destroy all PHI, unless return/destruction is not feasible, in which case protections will continue.
6. Indemnification
Each Party shall indemnify, defend, and hold harmless the other Party against all claims, damages, fines, penalties, or costs arising from the Party’s breach of this Agreement or violation of HIPAA.
7. Limitation of Liability
Except for obligations relating to HIPAA violations, willful misconduct, or gross negligence, neither Party shall be liable for indirect, incidental, or consequential damages.
8. Miscellaneous
8.1 Governing Law – This Agreement is governed by the laws of the State of the provider practicing without regard to conflicts principles.
8.2 Entire Agreement – This Agreement constitutes the entire understanding of the Parties regarding the Services and HIPAA compliance.
8.3 Amendments – Any amendment must be in writing and signed by both Parties.
8.4 Survival – HIPAA-related obligations survive termination of this Agreement.
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.
Name of the Provider Name:
Tabendi Healthcare Network
Chool Liyanapatabendi, CEO
Exhibit A – Services & Fees
1. Services Provided by Tabendi Healthcare Network
THN will provide the following services (“Services”) to the Provider:
2. Fees
Exhibit B – HIPAA Security Safeguards Summary
Tabendi Healthcare Network implements the following safeguards in compliance with the HIPAA Security Rule (45 C.F.R. §§164.302–318):
1. Administrative Safeguards
2. Technical Safeguards
3. Physical Safeguards
4. Breach Notification Process