This form is intended to serve as a sample for Michigan attorneys assisting clients with forms for HIPAA compliance. Under HIPAA
preemption standards a HIPAA form is not intended to replace a current form being used in compliance with applicable Michigan law.
Use of the sample HIPAA forms will require integration of the HIPAA sample form with existing forms currently in use. The attorney
also may wish to consult the HIPAA Matrix to determine if any preemption issue under Michigan law needs to be addressed in the
form. This form is for educational purposes only and does not constitute, and may not be relied upon, as legal advice.
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BUSINESS ASSOCIATE CONTRACT
This Business Associate Contract is between _____________________________
(“Covered Entity”), a Michigan Corporation, and ______________________________
Covered Entity acknowledges that it is subject to the Privacy Rule (45 CFR Parts
160 and 164) promulgated by the United States Department of Health and Human
Services pursuant to the Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-191.
Business Associate provides services to Covered Entity. The arrangements by
which Business Associate renders services to Covered Entity are set forth in a written
agreement (“the Services Agreement”. In the course of providing such services to
Covered Entity, Business Associate may come into contact with, use or disclose
Protected Health Information (“PHI”) of individuals
This Business Associate Contract (“Contract”) shall be considered an amendment to the
Service Agreement and shall remain in effect during the entire period the Services
Agreement is in effect. In addition, portions of this Contract shall remain in effect
subsequent to the termination of the Services Agreement, as provided in this Contract.
This form is intended to s