HIPAA Business Associate Agreement Generator

Covered Entity Name

Address

Business Associate Name

Address

Type of Services

Description of Services

Types of PHI Accessed

Medical Records

Billing Information

Demographic Information

Insurance Information

Psychotherapy Notes

PHI Format

Require encryption at rest and in transit

Require access controls and authentication

Require audit logs of PHI access

Require workforce HIPAA training

Require background checks for personnel

Breach Notification Timeline

Security Contact Email

Allow use of subcontractors with PHI access

Require prior written approval for subcontractors

Effective Date

Term

PHI Return/Destruction Timeline

State

Agreement Details