Stephen T. Carosello, DDS

Privacy Standards if disclosed by Covered Entity, except that Vendor may disclose PHI in a manner permitted pursuant to this Addendum or as required by law. To the extent Vendor discloses PHI to a third party. Vendor must obtain, prior to making any such disclosure,

a. Reasonable assurances from such third party that such PHI will be held confidential as provided pursuant to this Addendum and only disclosed as required by law or for the purposes for which it was disclosed to such third party, and
b. An agreement from such third party to immediately notify Vendor of any breaches of the confidentiality of the PHI, to the extent it has obtained knowledge of such breach.

3. Duties of Vendor. Vendor further agrees:

a. To report to the designated privacy officer of Covered Entity, in writing any use or disclosure of PHI in violation of this Addendum of which Vendor becomes aware within five (5) days of Vendor becoming aware of such unauthorized use or disclosure;
b. To use commercially reasonable efforts to prevent the use or disclosure of PHI other than pursuant to this Addendum;
c. To require all of its employees, subcontractors or agents that receive or use or have access to PHI under this Addendum to agree in writing to adhere to the same restrictions and conditions on the use and disclosure of PHI that are contained herein, including the duty to return or destroy the PHI as provided under section (2) hereof.
d. To make available all records, books, agreements, policies, and procedures relating to the use and disclosure of PHI to the Secretary of he Department of Health and Human Services (“DHHS”) for purposes of determining the Covered Entity’s compliance with the Privacy Regulation, subject to attorney-client and other applicable legal privileges.
e. To make available during normal business hours at Vendor’s offices all records, books, agreements, policies and procedures relating to the use and disclosure of protected health information to the Covered Entity, within ten (10) days of a written request, for purposes of enabling Covered Equity to determine Vendor’s compliance with the terms of this Addendum;
f. Within ten (10) days of receiving a written request from Covered Entity, to provide to Covered Entity such information as is requested by Covered Entity to permit Covered Entity to respond to a request by the subject individual for amendment and for accounting purposes of the disclosures of the individual’s PHI in accordance with 45 C.F.R. § 164.526 and § 164.528 and
g. To return to Covered Entity or destroy, as requested by Covered Entity, within ten (10) days of the termination of his Addendum, all PHI in Vendor’s possession received from Covered Entity and retain no copies or back-up tapes.

4. Duties of Covered Entity. Covered Entity further agrees:

a.) To inform the Vendor promptly of any changes in the form of notice of privacy practices that Covered Entity provides to individuals pursuant to 45 C.F.R. § 164.520 and provide Vendor a copy of the then current notice;
b.) To inform Vendor promptly of any changes in, or withdrawal of, the consent or authorization provided to Covered Entity by individuals whose PHI may be used or disclosed by Vendor under this Agreement pursuant to 45 C.F.R. § 164.506 or § 164.508 and
c.) To inform Vendor promptly of any restrictions on the use or disclosure of PHI agreed to by the Covered Entity with the individual as provided for in 45 C.F.R. §164.522

5.) Term and Termination

a.) Term. This Addendum shall become effective on the Effective Date and shall continue in effect until either (i) termination of the Service Agreement or (ii) termination provided herein or by mutual agreement of the Parties.
b.) Termination

i. As provided for under 45 C.F.R. § 164.504(e)(2)(iii), Covered Entity may immediately terminate this Addendum and any related agreement if it determines that Vendor has breached a material provision of this Addendum. Alternatively, Covered Entity may choose to:

1.) Provide Vendor with written notice of the existence of an alleged material breach; and

2.) Afford Vendor an opportunity to cure said alleged material breach upon mutually agreeable terms. If termination as described I this section is not feasible. Covered Entity shall report the breach to the Secretary of DHHS.

ii. Covered Entity may immediately terminate this Addendum and any related agreement if the Parties cannot negotiate a mutually agreeable amendment to comply with final Standards for Security of PHI, as now proposed in 45 C.F.R. Part 162, within thirty (30) days of the publication of such final Standards for Security.

6.) No Third Party Beneficiaries. Nothing express or implied in this Addendum is intended to confer, upon any person other than the Parties hereto any rights, remedies, obligations, or liabilities whatsoever.

IN WITNESS WHEREOF, the parties hereto hereby set their hands and seals as of the ________day of ___________, 2003

___________________________________(“Vendor”)

By:________________________________________

____________________________(“Covered Entity”)

By:________________________________________

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