10-Data Sharing Assessment v2.docx
DOCX document 29 KB Posted
- Attached to
- Telephonic Interpreter Services and American Sign Language Video Remote Interpreter Services
- Solicitation number
- 25-06410
- Issued by
- San Bernardino County, California
About this file
This document is a Data Sharing Assessment form from Inland Empire Health Plan (IEHP), a California-based healthcare organization. The form is designed to comprehensively document and assess data sharing processes between IEHP and third-party vendors, with a specific focus on the types of sensitive information that will be transmitted, received, created, or maintained. The assessment covers detailed information about potential data exchanges, including personally identifiable information (PII) and medical or behavioral health information related to IEHP team members, members, and providers.
The form meticulously catalogs the specific types of sensitive data that may be shared, including personal identifiers like full names, addresses, contact information, social security numbers, and biometric data, as well as medical information such as diagnoses, treatment records, prescriptions, and healthcare payment details. The document also requires vendors to disclose whether they will use offshore resources or subcontractors and mandates a comprehensive review of data handling practices. This aligns with the related state and local contract opportunity for Telephonic Interpreter Services and American Sign Language Video Remote Interpreter Services, which explicitly prohibits the use of offshore subcontractors in service delivery.
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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 .