Complete_with_Docusign_HITECH_.pdf
PDF 13 MB Posted
- Attached to
- Master Agreement AZ|CTR071422
- Contract number
- CTR071422
- Issued by
- Arizona
About this file
This document is a Business Associate Agreement (BAA) between the Arizona Department of Child Safety (ADCS) and Elite Power Crew Homes LLC. The agreement is structured under the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and related privacy and security regulations. It establishes the terms for the business associate's handling of Protected Health Information (PHI) and Electronic Protected Health Information (ePHI).
The agreement outlines the business associate's obligations for safeguarding confidential health information, including requirements for data protection, breach notification, permitted uses and disclosures, minimum necessary standards, and record retention. The contract specifies that the business associate must implement appropriate safeguards, report any impermissible uses or disclosures, mitigate potential harmful effects, and ensure that any subcontractors or agents adhere to the same privacy and security standards. The term of the agreement appears to align with the underlying contract or intergovernmental agreement, with provisions for termination if there are material breaches or violations of HIPAA and HITECH regulations.
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Text version
Docusign Envelope ID: 899BF023-DAEB-4463-986D-0EF72D945A7E
Marisa Lucero
29th August 2024
Certificate Of Completion Envelope Id: 899BF023DAEB4463986D0EF72D945A7E Status: Completed
Subject: Complete with Docusign: HITECH .pdf
Source Envelope:
Document Pages: 8 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: 159.87.110.137
Record Tracking Status: Original
8/29/2024 1:08:06 PM
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
Senior Procurement Specialist
Arizona Department of Child Safety
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style
Using IP Address: 159.87.110.137
Sent: 8/29/2024 1:08:59 PM
Viewed: 8/29/2024 1:09:07 PM
Signed: 8/29/2024 1:09:25 PM
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 8/29/2024 1:08:59 PM
Certified Delivered Security Checked 8/29/2024 1:09:07 PM
Signing Complete Security Checked 8/29/2024 1:09:25 PM
Completed Security Checked 8/29/2024 1:09:25 PM
Payment Events Status Timestamps
| 2024-08-29T13:10:14-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .