Diederich, Inc. and its subsidiaries, hereafter referred to as "Agency" and parties utilizing this service hereafter referred to as "user" do hereby agree as follows,
WHEREAS, the U.S. Department of Health and Human Services ("HHS") has issued final regulations, pursuant to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), governing the privacy of individually identifiable health information obtained, created or maintained by certain entities, including healthcare providers (the "HIPAA Privacy Rule"); and
WHEREAS, the HIPAA Privacy Rule requires that the User enter into the Agreement with Agency in order to protect the privacy of individually identifiable health information maintained by the User ("Protected Health Information", or "PHI", as identified in the HIPAA Privacy Rule); and
WHEREAS, Agency and its employees, affiliates, agents or representatives may access paper and/or electronic records containing PHI in carrying out their obligations to the User pursuant to either an existing, perspective, or contemporaneously executed agreement for services ("Services Agreement"), and
WHEREAS, the Parties desire to enter into this Agreement to protect PHI, and to amend any agreements contained herein the parties agree as follows:
1. The Agency agrees to receive information from the User by virtue of this electronic collection process, facsimile, mail service and other means User and Agency may elect to transfer necessary information include telephonic means.
2. Agency and User agree to utilize due diligence to protect the PHI.
3. Agency and User agree that Agency may transmit by any and all means the PHI information as deemed appropriate by Agency to its intermediaries, carriers, and other insurance related parties necessary to facilitate the services of the Agency to User. This includes requested and prospective services of Agency.
4. Use and Disclosure of PHI to Provide Services. The Agency will not use or further disclose PHI (as such term is defined in the HIPAA Privacy Rule) other than to make use of PHI necessary to perform services to User either perspective or by agreement. All other uses not authorized by this agreement are prohibited.
5. Contemporaneous Service Agreements. In the event that User and Agency are not parties to a Services Agreement existing prior to this date, but instead enter into a services agreement, at the same time as executing this agreement, such agreement shall be attached as exhibit A, and incorporated here by reference. In the event of conflict between the terms of the service agreement, and this agreement, the terms and conditions of this agreement shall govern.
6. Agency may utilize the PHI in its possession for its proper management and administration and/or to fulfill any present or future legal responsibilities of the Agency.
7. Agency agrees to disclose the minimum necessary PHI in performing the activities called for in providing perspective or requested services.
8. Either party to this agreement may terminate this agreement by legal notification granting 30 days notice. Notices to Agency are to be made in writing, certified, return receipt requested, to Diederich, Inc., Steven R. Green, J.D., General Counsel, 506 W. Main Street, Carbondale, Illinois 62901.
9. All parties certify agreement to be bound this agreement by virtue of acceptance to proceed through this electronic media. No signatures are required as disclosure and continuance to restricted with certification of review of this agreement.
Jeffrey M. Diederich
President & CEO
Diederich Group Of Companies