Complete_with_Docusign_Business_HITECH.pdf
PDF 6 MB Posted
- Attached to
- Master Agreement AZ|CTR071430
- Contract number
- CTR071430
- Issued by
- Arizona
About this file
This document is a Business Associate Agreement (BAA) between the Arizona Department of Child Safety (ADCS) and Home of Opportunity LLC, executed in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). The agreement is designed to ensure the protection of Protected Health Information (PHI) and Electronic Protected Health Information (ePHI) in accordance with federal and state privacy and security regulations.
The agreement outlines the responsibilities of the Business Associate (Home of Opportunity LLC) in handling sensitive health information, including strict guidelines for use, disclosure, safeguarding, reporting, and termination of PHI. Key obligations include using PHI only for necessary business functions, maintaining confidentiality, implementing appropriate security measures, reporting any potential breaches within 1 business day, and ensuring that any subcontractors adhere to the same standards. The term of the agreement is tied to the underlying contract and will terminate when all PHI is destroyed or returned to ADCS, with provisions for extending protections if complete return or destruction is not feasible.
View the file
Other files
Show all 44
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
DocuSign Envelope ID: C97CAFED-973C-4837-B03E-6B16D3E2691B
3rd
June 2024
Marisa Lucero
Certificate Of Completion Envelope Id: C97CAFED973C4837B03E6B16D3E2691B Status: Completed
Subject: Complete with Docusign: Business HITECH.pdf
Source Envelope:
Document Pages: 9 Signatures: 1 Envelope Originator:
Certificate Pages: 1 Initials: 0 Marisa Lucero
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-07:00) Arizona
3003 N. Central Ave
14th Floor
Phoenix, AZ 85012
Marisa.Lucero@AZDCS.GOV
IP Address: 159.87.110.136
Record Tracking Status: Original
6/3/2024 8:05:16 AM
Holder: Marisa Lucero
Marisa.Lucero@AZDCS.GOV
Location: DocuSign
Security Appliance Status: Connected Pool: StateLocal
Storage Appliance Status: Connected Pool: AZDCS - Guardian (114816690) Location: DocuSign
Signer Events Signature Timestamp Marisa Lucero marisa.lucero@azdcs.gov
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style
Using IP Address: 159.87.110.136
Sent: 6/3/2024 8:05:58 AM
Viewed: 6/3/2024 8:06:06 AM
Signed: 6/3/2024 8:06:19 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 6/3/2024 8:05:58 AM
Certified Delivered Security Checked 6/3/2024 8:06:06 AM
Signing Complete Security Checked 6/3/2024 8:06:19 AM
Completed Security Checked 6/3/2024 8:06:19 AM
Payment Events Status Timestamps
| 2024-06-03T08:08:19-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .