HIPAA STATEMENT OF UNDERSTANDING
The purpose of this Statement is to inform ______________________, (hereinafter referred to as “Contractor”)
about potential access to information that comes under the purview of the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”). Below is a brief explanation of HIPAA and Contractor’s
responsibilities regarding HIPAA compliance.
HIPAA imposes numerous requirements on health care providers, health plans, and health care clearing houses
(“Covered Entities”) concerning the use and disclosure of individual Health Information. Geneva Worldwide
frequently provides language services to Covered Entities.
Health Information includes demographic data, that relates to: the individual’s past, present or future physical or
mental health or condition, the provision of health care to the individual, or the past, present, or future payment
for the provision of health care to the individual, and that identifies the individual or for which there is a
reasonable basis to believe can be used to identify the individual.
Health Information includes virtually all individually identifiable records pertaining to medical, physical, or
psychological health received in writing, in an electronic medium, or as an oral communication.
Covered Entities are required to maintain the privacy of Health Information and to provide patients with notice
of their legal duties and privacy practices with respect to Health Information. HIPAA generally allows the use
and disclosure of Health Information, without a patient’s authorization, for purposes of health care treatment,
payment activities, and health care operations. Some examples of allowable use and disclosure are:
1.
2.
3.
4.
Patient treatment and care coordination
Payment to doctors and hospitals
To protect the public's health, such as by reporting when the flu is in your area, and
To make required reports to the police, such as reporting gunshot wounds.
A patient’s written authorization is required for any use or disclosure of Health Information that is not for
treatment, payment or health care operations, or otherwise permitted or required by HIPAA. A Covered Entity
must make reasonable efforts to use, disclose, and request only the minimum amount of Health Information needed to
accomplish the intended purpose of the use, disclosure, or request. Without patient authorization, a Covered Entity
generally cannot give patient information to an employer, use or share patient information for marketing or
advertising purposes, or share private notes about patient health care.
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Covered Entities must comply with a patient’s right to:
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Ask to see and get a copy of his or her health records
Have corrections added to his or her Health Information
Receive notices regarding the use and disclosure of Health Information,
Grant or deny permission for the disclosure of Health Information for purposes such as marketing or
advertising.
If a patient believes his rights are being denied or his Health Information isn’t being protected, he or she can file
a complaint with either his provider, health insurer, or the U.S. Government.
When a Covered Entity uses a contractor such as Geneva Worldwide, Inc. or other non-workforce member to
perform business associate services or activities, HIPAA requires that the Covered Entity include certain
protections for Health Information in a business associate agreement.
Covered Entities that use Geneva Worldwide to perform language services (a business associate service) require
Geneva Worldwide to sign a business associate agreement imposing specified written safeguards on Health
Information used or disclosed by Geneva Worldwide and our Contractors. For this reason, Geneva Worldwide
requires Contractors to sign HIPAA agreements at the request of the client.
By signing below, Contractor acknowledges he/she has been informed that executing a HIPAA agreement when
requested to do so by either Geneva Worldwide, Inc., or Geneva Worldwide’s client for whom Contractor is
providing services, may be a requirement. Failure to execute a requested HIPAA agreement may result in
termination of Contractor’s agreement with Geneva Worldwide, Inc.
Contractor Signature
Date
Contractor Name (PLEASE PRINT)
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