Business Associate Agreement

Business Information
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Please Provide business associate name!
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Please Provide Contact Email!
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Please Provide Contact Phone!
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Please Provide your HIPAA Security/Privacy Officer name!
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Please Provide the services you will provide!
Background



Subcontractors
Business Information
Business Associate Name Shakir
Phone Number 9356459950
Email Address [email protected]
HIPAA Security/Privacy Officer Ansari
Services you will provide Physical
Do you currently have a BAA signed with the covered entity? NO

Background

Has your company conducted HIPAA Training? Yes
Date of your most recent HIPAA Training 10/09/2020
Has your company undergone a Risk Assessment Yes
Date of your most recent Risk Assessment 12/09/2020
Do you have a set of polices and procedures? Yes
Has the organization been investigated for a HIPAA violation? yes
Explanation Reason for vialoation

Subcontractors

Company Name Veines
Contact Name Ravi
Phone 9153595860
Email [email protected]
Are they verified as HIPAA compliant? Yes
Business Associate Signature

Congrats! You have successfully completed your BAA Paperwork!

HIPAA

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