This Business Associate Agreement (“Agreement”) is entered into between Childhood Interventions, LLC (“Business Associate”), the developer and operator of this Provider Management System, and the early intervention provider or organization identified during account setup (“Covered Entity”). This Agreement is effective on the date the Covered Entity accepts it electronically. This Agreement is required by the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (collectively, “HIPAA”) and governs Business Associate’s handling of Protected Health Information (“PHI”) created, received, maintained, or transmitted on behalf of Covered Entity through this platform.
Terms used but not otherwise defined in this Agreement have the meanings given in HIPAA. “Protected Health Information” or “PHI” means individually identifiable health information transmitted or maintained in any form or medium that relates to the past, present, or future physical or mental health of an individual, the provision of health care to an individual, or payment for health care, and that identifies or could reasonably be used to identify the individual. “Services” means the Provider Management software platform, including caseload management, billing tracking, session scheduling, and related features provided by Business Associate. “Subcontractors” means third-party service providers engaged by Business Associate, including Google (Google Sheets, Google Calendar, Google Maps) where data is stored in accounts owned and controlled by Covered Entity.
Business Associate may use and disclose PHI only to provide the Services described in this Agreement, including managing caseloads, tracking billing, and related functions. Business Associate shall not sell PHI or use it for marketing. The Provider Management System stores data in your own Google Sheet, meaning Covered Entity retains direct control and ownership of all PHI.
Business Associate agrees to implement appropriate administrative, physical, and technical safeguards to protect PHI. PHI in this system resides in your Google Sheets account, protected by Google’s infrastructure and your Google account security. Business Associate does not retain copies of your caseload data on its own servers beyond what is transiently processed for the Services.
Business Associate will report to Covered Entity any use or disclosure of PHI not permitted by this Agreement within thirty (30) days of discovery, and any Security Incident within sixty (60) days of discovery. Report breaches to: privacy@childhoodinterventions.com
Because PHI in this system is stored in your own Google Sheet, Covered Entity has direct access to inspect, copy, amend, or delete PHI at any time. Covered Entity is responsible for responding to patient rights requests under HIPAA.
Covered Entity agrees to: (a) obtain any required consents before entering PHI; (b) maintain appropriate security over Google account credentials; (c) not share access credentials with unauthorized individuals; (d) promptly notify Business Associate of any suspected breach; (e) ensure only authorized personnel access this system.
This Agreement is effective on the date of electronic acceptance and remains in effect for as long as Covered Entity uses this system. Upon termination, Covered Entity retains full ownership of and access to all data in their Google Sheet. Because data is stored in Covered Entity’s own Google account, Business Associate has no data to return or destroy on its end.
Governing Law: This Agreement is governed by applicable federal law and the laws of the State of Florida. Amendment: Business Associate may amend this Agreement as required by changes in HIPAA, with at least 30 days’ notice. Questions: privacy@childhoodinterventions.com
By signing below, you confirm you are authorized to enter into this Agreement on behalf of your organization, have read and understood it, and agree to be bound by its terms.
Your acceptance will be recorded with a timestamp. Questions? Contact privacy@childhoodinterventions.com
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| Child | Service Date | Type | ESDS Status | Charge | Amt Paid | Claim ID |
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| Child | Service Date | Type | Charge | Status | DOB | Medicaid # | Payor | Start Time | Issue |
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| Service Date | Type | Charge | Bill Date | Pay Date | Amt Paid | Status | Start Time | Claim ID |
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| Child | Service Date | Type | Charge | Bill Date | Pay Date | Amt Paid | Status | Start | Stop |
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| Rate: | $0.445 per mile |
| Total Reimbursement: | — |
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