HomeMy WebLinkAboutData Use Agreement for Limited Data Set between KCPHD and KVH(1)Today's Date
04/05/2017
Fund/Department
116 -Public Health
s\
Kittitas County f'
Review Form �--
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
Contract /Grant Agency: Data Use Agreement for Limited Data Set between KCPHD and KVH
Period Begin Date: 04/17/2017 Period End Date: 04/17/2022
Total Grant/Contract Amount: $None
Grant/Contract Number:
Contract/Grant Summary:
The purpose of the Data Use Agreement for Limited Data Set between KCPHD and KVH is to provide
recipient with access to a limited data set for special department projects in accord with the HIPAA
Regulations.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature:
Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Date
Signature of Board of Health member Date
Financial Information
Total Amount $ State Funds $ Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In -Kind $
Grant/Contract Review Page 1
Is Equipment being purchased?Who owns equipment?
New Personnel being hired? i Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form No ❑ why not
New Division Created?
Revenue Code
Pass Through Information
Agency to Pass Through
Amount to Pass Through
$
Sub -Contract Approved
Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No ❑
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature:
Department:
Assignment of Tracking Information
Reviewer I Date
Grant/Contract Review Page 2'
DATA USE AGREEMENT FOR LIMITED DATA SET
This Data Use Agreement ("Agreement"), effective as of 20 ("Effective Date"),
is entered into by and between _ ("Recipient") and
Kittitas Valley Healthcare ("Covered Entity"). The purpose of this Agreement is to provide Recipient
with access to a Limited Data Set ("LDS") for use in the following titled research project:
._------ __._ (Project Name)
in accord with the HIPAA Regulations.
1. Definitions. Unless otherwise specified in this Agreement, all capitalized terms used in this
Agreement not otherwise defined have the meaning established for purposes of the "HIPAA
Regulations" codified at Title 45 parts 160 through 164 of the United States Code of Federal
Regulations, as amended from time to time.
2. Preparation -of the LDS. Covered Entity shall prepare and furnish to Recipient a LDS in accord with
the HIPAA Regulations.
3. Minimum Necessary Data Fields in the LDS. In preparing the LDS, Covered Entity or its Business
Associate shall include the data fields which are the minimum necessary to accomplish the
purposes set forth in Section 5 of this Agreement.
4. Responsibilities of Reci_3ient. Recipient agrees to:
a. Use or disclose the LDS only as permitted by this Agreement or as required by law;
b. Use appropriate safeguards to prevent use or disclosure of the LDS other than as
permitted by this Agreement or required by law;
C. Report to Covered Entity any use or disclosure of the LDS of which it becomes aware
that is not permitted by this Agreement or required by law, including the presence of
prohibited identifiers in the LDS;
d. Require any of its subcontractors or agents that receive or have access to the LDS to
agree to the same restrictions and conditions on the use and/or disclosure of the LDS
that apply to Recipient under this Agreement; and
e. Not use the information in the LDS, alone or in combination to identify or contact the
individuals who are data subjects.
5. Permitted Uses and Disclosures of the LDS. Recipient may use and/or disclose the LDS only for
the Research described in this Agreement or as required by law.
6. Term and Termination.
a. Term. The term of this Agreement shall commence as of the Effective Date and
terminate 5 years from Effective Date. Should the Recipient desire to keep the LDS for a
longer period, a justification in writing should be made to the Covered Entity.
b. Termination by Recipient. Recipient may terminate this agreement at any time by
notifying the Covered Entity and returning or destroying the LDS.
C. Termination by Covered Entity. Covered Entity may terminate this agreement at any
time by providing thirty (30) days prior written notice to Recipient.
d. For Breach. Covered Entity shall provide written notice to Recipient within ten (10) days
of any determination that Recipient has breached a material term of this Agreement.
Covered Entity shall afford Recipient an opportunity to cure said alleged material breach
upon mutually agreeable terms. Failure to agree on mutually agreeable terms for cure
within thirty (30) days shall be grounds for the immediate termination of this Agreement
by Covered Entity.
e. Effect of Termination. Sections 1, 4, 5, 6(e) and 7 of this Agreement shall survive any
termination of this Agreement under subsections c or d.
7. Miscellaneous.
a. Change in Law. The parties agree to negotiate in good faith to amend this Agreement
to comport with changes in federal law that materially alter either or both parties'
obligations under this Agreement. If the parties are unable to agree to mutually
acceptable amendment(s) by the compliance date of the change in applicable law or
regulations, either Party may terminate this Agreement as provided in section 6.
b. Construction of Terms. The terms of this Agreement shall be construed to give effect to
applicable federal interpretative guidance regarding the HIPAA Regulations.
C. No Third Party Beneficiaries. Nothing in this Agreement shall confer upon any person
other than the parties and their respective successors or assigns, any rights, remedies,
obligations, or liabilities whatsoever.
d. Counterparts. This Agreement may be executed in one or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute one and the
same instrument.
IN WITNESS WHEREOF, each of the undersigned has caused this Agreement to be duly executed in its
name and on its behalf.
COVERED ENTITY RECIPIENT
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