This Agreement is entered into by and between First Image / Pregnancy Resource Centers (FI/PRC) and (“Ministry Partner”) to protect the confidentiality of all clients and personnel at FI/PRC. These are the terms and conditions under which Protected Health Information (“PHI”), as defined by the Health Insurance Portability and Accountability Act of 1996 & 2003 (HIPAA) and Regulations enacted hereunder, created or received by Ministry Partner on behalf of FI/PRC may be used or disclosed. HIPAA regulations pertinent to FI/PRC’s ministry are described in FI/PRC’s
Policies and Procedures and on the Notice of Privacy Policies, posted at all FI/PRC locations.
Ministry Partner shall be defined as any volunteer or staff member who is involved in FI/PRC’s ministry. This would include all staff, and all volunteers in the centers, at headquarters, on advisory councils, on the board of directors, or other volunteer
position, whether temporary or permanent.
This agreement shall commence on and the obligations herein shall continue in effect so long as Ministry Partner uses, discloses, creates or otherwise possesses any PHI created or received on behalf of FI/PRC and until all PHI created or received by Ministry Partner on behalf of FI/PRC is destroyed or returned to FI/PRC pursuant to Paragraph 8 herein.
1) FI/PRC and Ministry Partner hereby agree that Ministry Partner shall be permitted to use and/or disclose PHI created or received on behalf of FI/PRC within the scope of need, or as necessary to achieve, the obligations and responsibilities of Ministry Partner in performing on behalf of, or providing services to FI/PRC.
2) Ministry Partner may use and disclose PHI created or received by Ministry Partner on behalf of FI/PRC if necessary, when such disclosure is required by law.
3) Ministry Partner hereby agrees to maintain the security and privacy of all PHI in a manner consistent with Oregon State and Federal laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 & 2003 (“HIPAA”) and regulations hereunder, and all other applicable law.
4) Ministry Partner agrees to maintain a record of all disclosures of PHI, as prescribed by FI/PRC’s Policies and Procedures.
5) Ministry Partner agrees to immediately report to their supervisor at FI/PRC any unauthorized use or disclosure of PHI by Ministry Partner. A Privacy/Security Incident Report will be submitted to FI/PRC within five (5) working days of such disclosure
6) In the event Ministry Partner fails to perform the obligations under this Agreement, FI/PRC may, at its option: Suspend or terminate Ministry Partner’s volunteer service at FI/PRC Suspend or terminate Ministry Partner’s employment at FI/PRC Limit or discontinue Ministry Partner’s access to PHI while at FI/PRC.
7) FI/PRC may immediately terminate this Agreement and related agreements if FI/PRC determines that Ministry Partner has breached a material term of this Agreement.
8) Upon termination of this Agreement, Ministry Partner shall return or destroy all PHI received from FI/PRC, or created or received by Ministry Partner on behalf of FI/PRC and that Ministry Partner maintains in any form, and
shall retain no copies of such information.