THIS IS A TEMPLATE ONLY. CERTAIN STATES MAY NOT
PERMIT THE TYPES OF ACTIVITIES ALLOWED HEREUNDER RELATING
TO PROTECTED HEALTH INFORMATION. THUS THIS AGREEMENT MAY
NEED TO BE MODIFIED IN ORDER TO COMPLY WITH MORE
RESTRICTIVE, APPLICABLE STATE LAW.
Where indicated below, Option 1 provisions are for use when this business
associate agreement will be an amendment, addendum or rider to an existing services
agreement and Option 2 provisions are for use when this business associate agreement will be
the only written agreement between the parties regarding the business associate services to be
provided. All other provisions of the agreement can be included in both options.
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement (this “B.A. Agreement”), dated
______________, 200_, is entered into by and between _________________, with an
address at _______________ (the “Business Associate”) and ________________, with an
address at _____________________ (the “Covered Entity”) (each a “Par