ࡱ> cfbQ Ebjbj++ {SIoeIoeh6X $???Pdt?:g(pJ9L9L9L9L9L9L9$<Q?tp99"p99*e)e)e)8J9e)J9e)e)f6|7""cY 6699<:6? Z?$7?7Xe)p9p9S%:? :  This Data Use Agreement (DUA) is entered into by The University of South Florida Board of Trustees for the University of South Florida (insert name of data provider) (Provider) and ____________________________________ (Recipient) as named on Schedule 1 (attached to and made a part of this DUA ) as of the effective date noted on Schedule 1. Provider is providing certain Protected Health Information (PHI) to Recipient in the form of a limited data set for the purpose(s) identified in paragraphs 4 and 5 of Schedule 1. In connection with the provision of that PHI, under the Health Insurance Portability and Accountability Act and its implementing regulations (collectively HIPAA), Provider is required to obtain assurances from Recipient that Recipient will only use or disclose PHI as permitted. The parties enter into the DUA as a condition of Providers furnishing of the limited data set to Recipient, and as a means of Recipients providing assurances about its use and disclosure. The provisions of this DUA are intended to meet HIPAA data use agreement requirements. The parties agree as follows: Definitions. Each capitalized term used in this DUA and not otherwise defined, will have the meaning given it in HIPAA. Term. This DUA commences on the effective date and continues until terminated in accordance with Section 4 below. Recipients Obligations. Recipient must: Comply with all applicable federal and state laws and regulations relating to the maintenance, safeguarding, and use and disclosure of the PHI. Use and disclose the PHI only for the purpose(s) identified in paragraphs 4 and 5 of Schedule 1, as otherwise required by law, and for no other purpose. Use appropriate safeguards to prevent the use and disclosure of the PHI, other than for a use or disclosure expressly permitted by this DUA. Immediately report to Provider any use or disclosure of the PHI other than as expressly allowed by this DUA. To ensure that its employees and representatives comply with the terms and conditions of this DUA, and that its agents, Business Associates and subcontractors to whom Recipient provides the PHI agree to comply with the same restrictions and conditions that apply to Recipient under this DUA. Not identify or attempt to identify the information contained in the Limited Data Set, nor contact any of the individuals whose information is contained in the Limited Data Set. Not use or disclose more PHI than the minimum amount necessary to allow Recipient to perform its functions for the purpose identified in Schedule 1. Indemnify, defend and hold Provider harmless from all costs and expenses (including attorney fees) for any claims that relate to a release of PHI or that relate to a breach of Recipients obligations. Termination. Provider may terminate this DUA and any disclosures of PHI, upon 10 days notice to Recipient, if Recipient violates or breaches any material term or condition of this DUA. Provider may terminate this DUA without cause upon 30 days written notice. Upon termination, Recipient must promptly return or delete the limited data set received from Provider in connection with the purpose identified on Schedule 1. If return or deletion of the limited data set is not feasible, Recipient shall continue the protections required under this DUA for the Limited Data Set consistent with the requirements of this DUA and applicable HIPAA privacy standards. If Recipient ceases to do business or otherwise terminates its relationship with Provider, Recipient agrees to promptly, and in a timely manner, return or delete all information contained in the Limited Data Set received from Provider. Governing Law and Venue. Reserved. The parties have executed this DUA to be effective as of the effective date stated on Schedule 1. Recipient Name The University of South Florida Board of Trustees for University of South Florida By: By:  Print nameSignature Signature Title: Title:  Date:  Date:  Schedule 1 Effective date: Name of Provider Person and Department Releasing the limited data set: Name of Recipient of the limited data set: Purpose of limited data set disclosure: [ ]Research Study (please provide information below) Title:  Principal Investigator:  IRB #: Sponsor: [ FORMTEXT   ]Public Health[ FORMTEXT   ]Health Care Operations(i.e., Quality improvement, teaching, accreditation, the development of clinical guidelines.) 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