10-Data Sharing Assessment v2.docx
DOCX document 29 KB Posted
- Solicitation number
- 25-06606
- Issued by
- San Bernardino County, California
About this file
The document is a Data Sharing Assessment form from Inland Empire Health Plan (IEHP), detailing the parameters of a potential data sharing arrangement with a third-party vendor. The form comprehensively outlines the types of sensitive information that may be exchanged, including personally identifiable information (PII) and medical/behavioral health information about IEHP team members, members, and providers. The document seeks to establish the scope of data transmission, reception, creation, and maintenance between IEHP and an unnamed vendor, with specific attention to potential offshore resources or global workforce involvement.
The assessment form meticulously catalogs potential data elements that could be shared, ranging from personal identifiers like full names, addresses, and social security numbers to medical information such as diagnoses, treatment records, and healthcare payment details. The form appears to be a preliminary risk and compliance tool designed to evaluate the security and privacy implications of a potential data-sharing partnership, with sections dedicated to understanding the volume of data, transmission methods, and the specific characteristics of the information that may be exchanged between IEHP and the third-party vendor.
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Text version
Section A: IEHP Contact Information
IEHP Department(s) Using Service or Vendor
IEHP Point of Contact Name
IEHP Point of Contact Title
IEHP Point of Contact Extension
Section B: 3rd Party / Vendor Contact Information
Company Name:
Company Address:
Company Web Site:
Primary Contact Name:
Primary Contact phone number:
Primary Contact email address:
Estimated Start Date
Estimated End Date
Section C: Services Provided to IEHP (Please give detailed explanation)
Section D: How is/ will sensitive information be transmitted, received, created/ maintained between IEHP & 3rd Party/ Vendor? (Please give detailed explanation)
Section E: Will 3rd party/ Vendor use offshore resources/ subcontractor(s)/ have a global workforce? If Yes, please explain in detail regarding country/ countries & services that require this.
IEHP Da t a Sha r ing Ass e ssment F o r m
Section F: Identify the types of information that will be received, viewed, used, disclosed or handled by vendor
Personally Identifiable Information (PII)
WHO IS THE DATA ABOUT?
| IEHP |
| IEHP Team |
| IEHP |
| Members |
| Members |
| Providers |
Full first name
Full last name
Complete addresses smaller than a state
Date of Birth
Phone numbers
Fax numbers
Email addresses
Social Security numbers
Member health plan ID number
Banking or Financial accounts
Driver’s License numbers
Vehicle identifiers and serial numbers, including license plate numbers
Individual's Website URLs
Internet Protocol (IP) address numbers
Biometric identifiers, including finger, retinal and voice prints
Full face photographic images
Any other unique number characteristic or code directly related to an individual not listed above
Medical or Behavioral Health Information
WHO IS THE DATA ABOUT?
IEHP
IEHP Team Members
Members
Medical information including diagnosis, admission \ discharge dates, healthcare treatment, medical history, medical records, etc.
Prescriptions
Healthcare payment information including claims, bills, receipts and explanation of benefits
Ancillary services including x-rays and labs
Data or information related to the provision of health care to an individual not listed above
Section G: Number of persons information being shared Approximate number of persons whose information will be viewed, used, disclosed or handled
File details come from the government source that posted it. Updated .