4PMD, LLC strictly adheres to the Standards for Privacy of Individually Identifiable Health Information (45 C.F.R. 160.101-160.312; 164.312; 164.102-164.534) (“Privacy Regulations”) as promulgated by the U.S. Department of Health and Human Services (“HHS”)pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPPAA”) with respect to patient information once it is received by 4PMD, LLC ; and

Whereas, the non-medical user has engaged 4PMD, LLC to perform “Services” as defined below on a referral basis only; and

Whereas, in the performance of the Services, 4PMD, LLC must use/disclose Protected Health Information (PHI) , as that term is defined in Section 164.501 of the Privacy Regulations, received from the non-medical user; and

Whereas, 4PMD, LLC is committed to complying with the Privacy Regulations with respect to dealings between the Non-Medical user and 4PMD, LLC. Therefore no PHI will be transmitted to the Non-Medical User from 4PMD, LLC at any time. Test results (included in PHI) will be sent directly to the patient by the ordering physician using the contact information provided.

Now, therefore, in consideration of the mutual understanding of the information herein contained, the parties enter into a Business Associate Agreement

This Business Associate Agreement, effective , 2015, is entered into by and between Professional 4-PMD, LLC and , a (Professional Designation such as D.C. or M.D.) licensed to practice in the State of (the “Ordering Physician”) (each a “Party” and collectively the “Parties ”).

WHEREAS, Ordering Physician agrees to comply with the Standards for Privacy of Individually Identifiable Health Information (45 C.F.R. §§ 160.101-160.312; 164.102-164.534) ("Privacy Regulations") as promulgated by the U.S. Department of Health and Human Services ("HHS") pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) with respect to its dealings with 4PMD; and,

WHEREAS, the Ordering Physician has engaged 4PMD to perform "Services" as defined below; and,

WHEREAS, in the performance of the Services, 4PMD must use and/or disclose Protected Health Information ("PHI"), as that term is defined in Section 164.501 of the Privacy Regulations, received from or transmitted to the Ordering Physician; and,

WHEREAS, the Parties are committed to complying with the Privacy Regulations with respect to dealings between Ordering Physician and 4PMD;

NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, the Parties enter into this Business Associate Agreement ("Agreement").

4PMD, LLC provides laboratory testing services for both licensed health professionals and for patients referred by a non-medical provider. In addition 4PMD, LLC provides educational resources to patients and partners pertaining to blood testing, health, and wellness. Laboratory tests are for informational purposes only. It is not the intention of 4PMD to provide specific medical advice but rather to provide users with information to better understand your health. In the event of “critical” lab results as defined by the laboratory, a 4PMD doctor will contact the patient as soon as results become available for review. In order to provide the best available cost to everyone, 4PMD, LLC does not accept any form of insurance including for blood tests and medical advice. 4PMD, LLC assumes no further responsibility beyond providing test results.

  • 4PMD, LLC agrees to not use or disclose Protected Health Information other than as permitted or required by the Agreement or as Required By Law.
  • 4PMD, LLC agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement.
  • 4PMD, LLC agrees to report to the patient any use or disclosure of the Protected Health Information not provided for by this Agreement of which it becomes aware.
  • 4PMD, LLC agrees to provide access, at the request of patient or as directed by the ordering physician, and in the time and manner, to Protected Health Information in a Designated Record Set in order to meet the requirements under 45 CFR § 164.524.

Obligations of 3rd party Ordering Physician (For medical doctors/health prof only)

Provisions for Ordering Physician to Inform 4PMD, LLC of Privacy Practices and Restrictions

  • Ordering Physician shall notify 4PMD, LLC of any limitation(s) in its notice of privacy practices of Clinician in accordance with 45 CFR § 164.520, to the extent that such limitation may affect 4PMD, LLC use or disclosure of Protected Health Information.
  • Ordering Physician shall notify 4PMD, LLC of any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, to the extent that such changes may affect 4PMD, LLC’s use or disclosure of Protected Health Information.
  • Ordering Physician shall notify 4PMD, LLC of any restriction to the use or disclosure of Protected Health Information that Ordering Physician has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect 4PMD, LLC use or disclosure of Protected Health Information.

General Use and Disclosure Provisions Specify purposes:

Except as otherwise limited in this Agreement, 4PMD, LLC may only use or disclose Protected Health Information on behalf of, or to provide services to, the ordering physician and the patient for whom the tests were ordered.

  • Except as otherwise limited in this Agreement, 4PMD, LLC may use Protected Health Information for the proper management and administration of the 4PMD, LLC or to carry out the legal responsibilities of 4PMD, LLC.
  • Except as otherwise limited in this Agreement, 4PMD,LLC may disclose Protected Health Information for the proper management and administration of 4PMD, LLC , provided that disclosures are Required By Law.
  • Except as otherwise limited in this Agreement, 4PMD, LLC may use Protected Health Information to provide Data Aggregation services to the ordering physician.
  • 4PMD, LLC may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with § 164.502(j)(1).

Non-medical users shall not request to receive Protected Health Information. Non-medical users shall not direct or make requests on behalf of the patient unless the patient has provided written consent.

  • Term. The Term of this Agreement shall be effective on the date of registration, and shall terminate when all of the Protected Health Information provided by the patient to 4PMD, LLC, or created or received by 4PMD, LLC on behalf of a 3rd party Ordering Physician, is destroyed or returned to the Ordering Physician, or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this Section.
  • Termination for Cause. Upon 3rd party Ordering Physician’s knowledge of a material breach by 4PMD, LLC , Ordering Physician shall either:
    • Provide an opportunity for 4PMD, LLC to cure the breach or end the violation and terminate this Agreement if 4PMD,LLC does not cure the breach or end the violation within the time specified by the 3rd party Ordering Physician;
    • Immediately terminate this Agreement if 4PMD, LLC has breached a material term of this Agreement and cure is not possible; or
    • If neither termination nor cure is feasible, Ordering Physician shall report the violation to the Secretary.
  • Effect of Termination.
    • Except as provided in paragraph (2) of this section, upon termination of this Agreement, for any reason, 4PMD, LLC shall return or destroy all Protected Health Information received from the 3rd party Ordering Physician, or created or received by 4PMD, LLC on behalf of the Ordering Physician. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of 4PMD, LLC. 4PMD, LLC shall retain no copies of the Protected Health Information.
    • In the event that 4PMD, LLC determines that returning or destroying the Protected Health Information is infeasible, 4PMD, LLC shall provide to 3rd party Ordering Physician notification of the conditions that make return or destruction infeasible. If return or destruction of Protected Health Information is infeasible, 4PMD, LLC shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as 4PMD, LLC maintains such Protected Health Information.