Business Associate Agreement - Standard by Common Paper
This document is a Business Associate Agreement (BAA) template designed to ensure compliance with HIPAA regulations concerning Protected Health Information (PHI). It comprises a customizable Cover Page for specific key terms and incorporates comprehensive BAA Standard Terms by reference. The agreement outlines the obligations of a Provider (acting as a Business Associate or Subcontractor) and a Company (acting as a Business Associate or Covered Entity) in handling PHI.
Using this document
This BAA has 2 parts:
The Key Terms on this Cover Page
The Common Paper BAA Standard Terms Version 1.0 posted at https://commonpaper.com/standards/business-associate-agreement/1.0 which is incorporated by reference.
Any modifications to the BAA Standard Terms should be made on the Cover Page. If there is any inconsistency between the parts of the BAA, the Cover Page will control over the BAA Standard Terms. Capitalized words have the meanings or descriptions given in the Cover Page or Standard Terms.
Key Terms
The key legal terms of this BAA are as follows:
Agreement
This BAA is incorporated into the [insert principal agreement].
Relationship
Provider is a [subcontractor | Business Associate].
Company is a [Business Associate | Covered Entity].
Breach Notification Period
[Drafting note: this time period cannot be more than 60 calendar days]
[ # ] [hours | business days | calendar days] from discovery.
Designated Record Set
[Drafting note: select one and delete the other]
( ) Provider maintains PHI in a Designated Record Set.
( ) Provider does not maintain PHI in a Designated Record Set.
Limitations
[Drafting note: The Standard Terms permit all four activities (Sections 1.7 and 3). Delete the entire section to allow these activities as specified in the Standard Terms. To prohibit or place limits on the extent to which these activities can be done select and specify those that apply.]
Subcontracting:
[ ] Provider will not subcontract.
[ ] Provider will not subcontract unless:
[ ] notice has been provided to Company as specified here: [free text box].
[ ] with Company’s explicit permission as specified here: [free text box].
Offshoring:
[ ] Offshoring of PHI and/or Services is not permitted.
[ ] Offshoring of PHI and/or Services not permitted unless [free text for specific offshoring rights or restrictions].
De-identification:
[ ] Provider will not de-identify PHI.
[ ] Provider will not de-identify PHI unless:
[ ] doing so for the specific purpose of [insert specific purpose(s) such as “generating data analytics for academic research”].
[ ] the following additional requirements for de-identifying PHI have been implemented: [free text box].
Aggregation:
[ ] Provider will not aggregate PHI.
[ ] Provider will not aggregate PHI unless [free text for specific aggregation restrictions].
BAA Effective Date
The date the BAA starts
[ x ] Date of last signature on this Cover Page.
[ ] [Fill in custom Effective Date].
Changes to BAA Standard Terms
Other Changes to BAA Standard Terms
Additional modifications or customizations:
[Fill in]
Provider and Company have not changed the BAA Standard Terms except for the details on the Cover Page above. By signing this Cover Page, each party agrees to enter into this BAA as of the BAA Effective Date.
PROVIDER: [provider official company name]\ COMPANY: [company official company name]
Signature [signature]
Print Name [name]
Title [title]
Notice Address [notice address]
Date
Business Associate Agreement
Business Associate Obligations
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