9-Data Sharing Assessment v2.docx
DOCX document 29 KB Posted
- Attached to
- Electronic Health Record System
- Solicitation number
- RFP-26-07045
- Issued by
- San Bernardino County, California
About this file
This is a Data Sharing Assessment Form for Inland Empire Health Plan (IEHP) used to evaluate third-party vendors and service providers who will have access to sensitive organizational and member information. The form is designed to document vendor details, services provided, data handling practices, and information security protocols for IEHP's Electronic Health Record System initiative in California. The assessment requires vendors to provide contact information, describe services delivered, explain data transmission and storage methods, disclose use of offshore resources or subcontractors, and identify all categories of information to be accessed, including personally identifiable information (PII) and medical or behavioral health information.
The form systematically catalogs the types of data that vendors may handle, encompassing PII such as names, addresses, dates of birth, Social Security numbers, health plan identification numbers, and biometric identifiers; as well as medical and behavioral health information including diagnoses, treatment records, prescriptions, claims, and healthcare payment data. Vendors must indicate whether they will access information related to IEHP employees, team members, or IEHP members and providers, and provide the approximate number of individuals whose information will be disclosed or handled. This assessment tool establishes a baseline for IEHP to evaluate vendor compliance with data protection requirements and to manage risks associated with sharing sensitive health information with external parties.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .