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Get a Business Associate Agreement (BAA)

For businesses that handle patient health information for a doctor, dentist or other health provider.

You

Name (person or business) (required)

Address

Email

Name of the person signing

Their title

Them

Name (person or business) (required)

Address

Email

Name of the person signing

Their title

What services do you provide to the health provider? (required)For example: billing, IT support, cleaning of patient areas.

Services you use from others (up to 10)

Other companies you use that may see patient health information, like cloud storage or shredding.

State whose laws applyUsually the state where you do business.

Date of the agreementLeave empty for today.

This is general information, not legal, tax or financial advice. For agreements, have a lawyer review before you sign.

SMPL House does not store or keep your records. Please download and save your file. To have copies saved for later, create a free account.