Complete_with_Docusign_Casa_DAmore_FC_HITEC.pdf
PDF 13 MB Posted
- Attached to
- Master Agreement AZ|CTR071412
- Contract number
- CTR071412
- Issued by
- Arizona
About this file
This document is a Business Associate Agreement (BAA) between the Arizona Department of Child Safety (ADCS) and Casa D'Amore Family Care, LLC, focused on compliance with the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and associated privacy and security regulations. The agreement establishes the terms for handling Protected Health Information (PHI) and Electronic Protected Health Information (ePHI) in accordance with federal and state privacy laws.
The agreement primarily governs the handling, protection, and disclosure of sensitive health information, with specific provisions for data security, confidentiality, and permissible uses of PHI. Key obligations include implementing appropriate safeguards to protect PHI, reporting any unauthorized use or disclosure, maintaining minimum necessary access to information, and ensuring that any subcontractors or agents are bound by the same privacy and security requirements. The contract appears to be effective through May 31, 2024, and includes detailed protocols for managing potential breaches, conducting audits, and addressing termination scenarios while maintaining the confidentiality and integrity of protected health information.
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Text version
DocuSign Envelope ID: C5B09E00-30E7-4D49-AB6A-240D11BB4526
Marisa Lucero
31st
May 2024
Certificate Of Completion Envelope Id: C5B09E0030E74D49AB6A240D11BB4526 Status: Completed
Subject: Complete with Docusign: Casa D'Amore FC HITECH 2024.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
5/31/2024 10:04:47 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: 5/31/2024 10:05:28 AM
Viewed: 5/31/2024 10:05:38 AM
Signed: 5/31/2024 10:05:54 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 5/31/2024 10:05:29 AM
Certified Delivered Security Checked 5/31/2024 10:05:38 AM
Signing Complete Security Checked 5/31/2024 10:05:54 AM
Completed Security Checked 5/31/2024 10:05:54 AM
Payment Events Status Timestamps
| 2024-05-31T10:06:52-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .