AMD 1 RE ORAL HEALTH SVCS WITH PEORIA USD.PDF

AGREEMENT NO: C-86-15-041-3-01 AMENDMENT NO: 1
AMENDMENT TO
INTERGOVERNMENTAL AGREEMENT (IGA)
Between
MARICOPA COUNTY
By and Through
DEPARTMENT OF PUBLIC HEALTH
and
PEORIA UNIFIED SCHOOL DISTRICT
I. The above named IGA is hereby amended as specified below:
A. Cover Page, under 3. Agreement Amount, replace the amount with $7,998.
(Budget period, July 1, 2015 – June 30, 2016);
B. Cover Page, under 6. Expiration Date will be extended to June 30, 2016.
C. Section IV, Work Statement, Page 12 and 13, will be deleted and replaced, with
attached revised Work Statement, Page 12 and 13, (Exhibit A).
D. Attachment A, Budget, will be deleted and replaced with attached updated
Attachment A, Budget. (Exhibit B).
E. Attachment B, Schedule, will be deleted in its entirety.
F. Attachment C. Business Associates Agreement will be added. (Exhibit C)
II. All other terms and conditions of the original contract and its amendments shall
remain in full force and effect.
1

AGREEMENT NO: C-86-15-041-3-01 AMENDMENT NO: 1
IN WITNESS WHEREOF, the parties agree to the changes indicated herein:
FOR AND ON BEHALF OF FOR AND ON BEHALF OF
MARICOPA COUNTY PEORIA UNIFIED SCHOOL DISTRICT
By: By:
Chairman, Board of Supervisors
Date Date
ATTEST ATTEST
Clerk of the Board
Date Date
APPROVED AS TO FORM APPROVED AS TO FORM
Attorney for Maricopa County
Date Date
2

EXHIBIT A: SECTION IV, WORK STATEMENT
SECTION IV WORK STATEMENT
1. DEFINITIONS:
A. MCDPH refers to Maricopa County Department of Public Health
B. MCOOH FTF refers to Maricopa County Office of Oral Health First Teeth First
C. PUSD refers to Peoria Unified School District
D. ADHS refers to Arizona Department of Health Services
2. SERVICE GOALS
Peoria Unified School District will provide coordination of transportation for preschool
children within the School District.
3. SERVICE OBJECTIVES/ACTIVITIES
A. Provide funding to Peoria Unified School District for the cost of the transportation
of children via buses in the First Things First Northwest Maricopa Region to
receive dental education, screenings and fluoride varnish at preschools in the
school district. Additionally, coordinate program at the schools, provide data
entry and report as necessary.
B. Site Coordinator will provide assistances on the date of services to move the
children from the buses to the location where oral health screenings, fluoride
varnish and education is being provided and the return back to the buses
following services.
C. Data Entry/Reporting personnel enter treatment records into the MCOOH FTF
database. All consent form information will be submitted to ADHS for billing
purposes.
4. OTHER REQUIREMENTS
MCOOH FTF shall:
A. Provide program information and parental consent forms in advance of
scheduled screening dates, to the site coordinator.
B. Provide licensed dental hygienist and trained bilingual site assistants to conduct
the dental screening and fluoride varnish application at each location.
C. Check State Board of Dental Examiners licensing records on licensed MCDPH
dental providers; conduct background checks of all dental providers.
D. Supply identification badges for dental providers.
E. Furnish/bring necessary dental supplies needed to conduct the basic oral
screening/fluoride varnish activities as the designated PUSD locations.

EXHIBIT A: SECTION IV, WORK STATEMENT
F. Provide oral health education materials for parents and teachers.
G. Maintain all student information according to confidentiality requirements
H. Collect all consent forms and treatment records upon completion of services.
I. Enter consent forms and treatment records into the MCOOH FTF centralized
database.
J. Provide secure transfer of data and forms to ADHS for billing and secure
storage.
PUSD shall:
A. Promote participation in the First Teeth First fluoride varnish program through
communication with teachers, school offices and parents.
B. Provide transportation coordination for students from scheduled elementary
schools to the services location on the date of scheduled services.
C. Use all forms, educational materials, protocols and guidelines used in other
MCOOH FTF oral health services delivery locations in the Region.
D. Provide MCOOH FTF with all forms at the conclusion of services.
E. Provide adequate physical space at each school for dental screening and fluoride
varnish services to be delivered.
F. Provide outreach to parents/guardians with children having urgent dental needs
so that referrals to dental services occur after the initial dental screening.

EXHIBIT B: BUDGET
Budget Period July 1, 2015 - June 30, 2016
Budget Category Line Item Requested Funds
Expenses
Site Coordination ($25.00/hr x 105 hours) $2,625
Data Entry/Reporting ($25.00/hr x 100 hours) $2,500
Subtotal $5,125
Transportation
Buses ($16.70/hr x 172 hours) $2,873
Subtotal $2,873
Grand Total $7,998

EXHIBIT C: Business Associates Agreement
Peoria Unified School District
6330 West Thunderbird Road
Glendale, AZ 85306
(602) 486-6066
BUSINESS ASSOCIATE AGREEMENT
This Agreement sets out the responsibilities and obligations of MARICOPA COUNTY (“Business Associate” or
“Associate”) as a business associate of the Peoria Unified School District (PUSD), a covered entity, under the
Health Insurance Portability and Accountability Act (“HIPAA”), the Health Information Technology for Economic and
Clinical Health (“HITECH”) Act, and pursuant to the Contract or Engagement Letter between Associate and PUSD.
PUSD may make available and/or transfer to Associate Protected Health Information (“PHI”) of individuals in
conjunction with Services, which Associate will use or disclose only in accordance with this Agreement. Associate
and PUSD agree to the terms and conditions of this Agreement in order to comply with the use and handling of PHI
under the HIPAA Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Part 160 and Part
164, Subpart E (“Privacy Standards”) and the HIPAA Security Standards, 45 C.F.R. Part 160 and Part 164, Subpart
C (“Security Standards”), both as amended from time to time. Unless otherwise provided, all capitalized terms in this
Agreement will have the same meaning as provided under the Privacy Standards and Security Standards. Associate
and PUSD will comply with the terms of this Agreement for the duration of the Contract or Engagement Letter and for
such other continuing periods as provided in this Agreement. Upon the compliance date of any final regulation or
amendment to final regulation promulgated by the Secretary of Health and Human Services that affects Associate’s
use or disclosure of PHI, the parties agree to take such reasonable action as is necessary to amend this Agreement
in order for PUSD to comply with such final regulation or amendment to final regulation.
Definitions for terms in this Agreement:
1. Business Associate or Associate means an entity that performs or assists in the performance of a function on
behalf of a Covered Entity, which involves the use, or disclosure of Individually Identifiable Health Information
as defined in 45 C.F.R. § 160.103. In addition, an Associate can be an entity that provides data transmission
services to a Covered Entity, is more than a mere conduit of information, and allows a Covered Entity to
access the maintained information in a manner beyond a random or infrequent basis. The terms “Business
Associate”, “Associate” and “Contractor” are synonymous. Notwithstanding this definition, if Contractor does
not have access to or create Protected Health Information under this Contract, Contractor is not an
Associate, and the terms of this Agreement do not apply to Contractor.
2. Contractors of Business Associate means a person or an entity to whom an Associate delegates a function,
activity, or service that the Associate has agreed to perform for a Covered Entity. A contractor of an
Associate which creates, receives, maintains, or transmits personal health information on behalf of the
business associate is itself a Business Associate and therefore will comply with the terms of this Agreement.
For purposes of this Agreement the term “Contractor” includes the Contractor, its employees, its
subcontractors and its agents.
3. Protected Health Information (“PHI”) means the health information that is created or received by a Covered
Entity; and relates to the physical condition, mental health or other health condition of an Individual, or to the
provision of health care to the Individual (including but not limited to the payment for such health care); and
identifies or can be used to identify the Individual as defined in 45 C.F.R. § 160.103.
Business Associate Agreement 1
Revised 06/22/2015

4. Individual shall have the meaning set forth in 45 CFR §160.103, including a person who is the subject of the
Protected Health Information, and shall include an individual or entity who qualifies as a personal, legal
representative of the person, as the context requires.
5. Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR
Parts 160 and 164, Subparts A and E, as may be amended, modified or superseded, from time to time.
6. Security Rule shall mean the Standards for Security of Individually Identifiable Electronic Health Information at
45 CFR Parts 160 and 164, Subparts A, C and E, as may be amended, modified or superseded, from time to
time.
7. Breach shall mean the acquisition, access, use or disclosure of Protected Health Information in a manner not
permitted by the HIPAA Privacy Rule, that compromises the security or privacy of the Protected Health
Information as defined, and subject to the exception given to such term in 45 C.F.R. § 164.402.
8. Breach Notification Rule shall mean the interim final rule related to breach notification for unsecured protected
health information at 45 C.F.R. Parts 160 and 164.
9. Covered Entity shall have the meaning given to such term in 45 C.F.R. § 160.103.
10. Designated Record Set shall have the meaning given to such term under the Privacy Rule at 45 C.F.R. §
164.501.
11. Security Incident shall have the meaning given to such phrase under the Security Rule at 45 C.F.R. § 164.304.
12. Unsecured PHI shall have the meaning given to such phrase under the Breach Notification Rule at 45 C.F.R. §
164.402.
13. Electronic Protected Health Information or ePHI shall have the same meaning given to such term under the
Security Rule, including, but not limited to, 45 C.F.R. § 160.103.
14. Electronic Media shall have the same meaning given to such term in 45 C.F.R. § 160.103.
15. Health Information Technology for Economic and Clinical Health (HITECH) Act, as codified at 42 U.S.C.
§§ 17921-17954.
16. Secretary shall mean the Secretary of the Department of Health and Human Services or his or her designee.
It is agreed by and between the parties that:
1. Uses and Disclosures of Protected Health Information. Associate will use and disclose PHI only for those
purposes necessary to perform its duties, obligations and functions under the Contract, or as otherwise
expressly permitted in this Agreement or as required by other law.
a. Associate will not use or further disclose any PHI in violation of this Agreement.
b. Associate may use PHI to perform data aggregation services as permitted by 45 C.F. R. § 164.504(e) (2)
(i) (B).
c. Associate agrees that anytime it provides PHI received from PUSD to a Contractor, its employees,
subcontractor, or agent to perform Services for PUSD, Associate first will enter into a contract with such
Contractor, employees, subcontractor or agent that contains the same terms, conditions, and restrictions
on the use and disclosure of PHI as contained in this Agreement.
d. If Associate maintains a Designated Record Set, PUSD will provide Associate with copies of applicable
policies and procedures, which the Associate will comply with as related to an individual’s right to access
PHI; request an amendment to PHI; request confidential communications of PHI; or request an
accounting of disclosures of PHI.
Business Associate Agreement 2
Revised 06/22/2015

2. Associate Use or Disclosure of Protected Health Information for its Own Purposes. Associate may use or
disclose PHI received from PUSD for Associate’s management and administration, or to carry out Associate’s
legal and contractual responsibilities. Associate may disclose PHI received from PUSD to a third party for such
purposes only if:
a. The disclosure is required by law; or
b. Associate secures written assurance from the receiving party that the receiving party will: (i) hold the PHI
confidentially; (ii) use or disclose the PHI only as required by law or for the purposes for which it was
disclosed to the recipient; and (iii) notify the Associate of any breaches in the confidentiality of the PHI.
c. Associate may use and disclose de-identified health information, if (i) the use is disclosed to PUSD and
permitted by PUSD in its sole discretion, (ii) that the de-identification is in compliance with 45 C.F.R. §
164.502(d), and (iii) the de-identified health information meets the standard and implementation
specifications for de-identification under 45 C.F.R. § 164.514(a) and (b).
d. Associate shall use and disclose PHI only to the extent reasonably necessary to accomplish the intended
purpose of such PHI.
3. Safeguards. Associate will implement and maintain appropriate safeguards to prevent any use or disclosure of
PHI not otherwise permitted in this Agreement.
a. Associate also will implement administrative, physical and technical safeguards to protect the
confidentiality, integrity, and availability of any electronic protected health information (“e-PHI”), if any,
that Associate creates, receives, maintains, and transmits on behalf of PUSD.
b. Upon request of PUSD, Associate will provide evidence to PUSD that these safeguards are in place and
are properly managed.
4. Reports of Improper Use or Disclosure of Secure or Unsecure Protected Health Information and of
Security Incidents and Breaches. Associate will report in writing to PUSD any use or disclosure of PHI,
including any breach, not permitted by the contract between Associate and PUSD within five (5) days of
Associate’s learning of such use, disclosure or breach or within five (5) days following the exercise of
reasonable diligence would have known of the improper use, disclosure, or breach.
5. Mitigation of potential harmful effects. Associate shall mitigate all potential harmful effects of a use or
disclosure of Protected Health Information by Business Associate in violation of the requirements of this
Agreement. Immediately following the Associate’s discovery of a Breach (or upon the Associate’s reasonable
belief that a Breach has occurred), Associate shall provide PUSD with sufficient information to permit PUSD to
comply with the Breach notification requirements set forth at 45 C.F.R. §164.400 et seq.
a. Specifically, if the following information is known to (or can be reasonably obtained by) the Associate,
Associate will provide to PUSD all available information that PUSD is required to include in its notification
to the individual pursuant to the Breach Notification Rule, including but not limited to:
i. contact information for individuals who were or who may have been impacted by the Breach (e.g.,
first and last name, mailing address, street address, phone number, email address);
ii. a brief description of the circumstances of the Breach, including the date of the Breach, the date of
discovery of the Breach, and the identity of who accessed and received the Unsecured PHI;
iii. a description of the types of unsecured PHI involved in the Breach (e.g., names, social security
number, date of birth, address(s), account numbers of any type, disability codes, diagnostic and/or
billing codes and similar information);
iv. a brief description of what the Associate has done or is doing to investigate the Breach, mitigate
harm to the individual impacted by the Breach, and protect against future Breaches; and
Business Associate Agreement 3
Revised 06/22/2015

v. contact information for a liaison appointed by the Associate with whom PUSD may ask questions
and learn additional information concerning the Breach.
b. Following a Breach, Associate will have a continuing duty to inform PUSD of new information learned by
Associate regarding the Breach, including but not limited to the information described in items (1) through
(5), above.
c. Associate also will report in writing to PUSD any Security Incident (successful or unsuccessful) of which
Associate becomes aware within five (5) business days of Associate learning of such use or disclosure.
Specifically, Associate will report to PUSD any unauthorized access, use, disclosure, modification, or
destruction of e-PHI or interference with system operations in an information system containing e-PHI of
which Associate becomes aware, provided that:
i. such reports will be provided only as frequently as the parties mutually agree, but no more than once
per month; and
ii. if the definition of “Security Incident” under the Security Standards is amended to remove the
requirement for reporting “unsuccessful” attempts to use, disclose, modify or destroy e-PHI, the
portion of this Section 5 addressing the reporting of unsuccessful, unauthorized attempts will no
longer apply as of the effective date of such amendment.
6. Obligations Regarding Associate Personnel. Associate will appropriately inform all of its employees, agents,
representatives, members of its workforce, and Contractors, its employees, subcontractors, or agents of
Associate (“Associate Personnel”), whose services may be used to satisfy Associate’s obligations under the
Contract and this Agreement of the terms of this Agreement. Associate represents and warrants that the
Associate Personnel are under legal obligation to Associate, by contract or otherwise, sufficient to enable
Associate to fully comply with the provisions of this Agreement. Associate will maintain a system of sanction for
any Associate Personnel who violates this Agreement.
7. Access to Protected Health Information.
a. PUSD Access. Within five (5) business days of a request by PUSD for access to PHI received from
PUSD, Associate will make requested PHI available to PUSD.
b. Patient Access. If a Patient requests access to PHI directly from Associate, Associate will within five (5)
business days forward such request in writing to PUSD. PUSD will be responsible for making all
determinations regarding the grant or denial of a Patient’s request for PHI and Associate will make no
such determinations. Only PUSD will release PHI to the Patient pursuant to such a request.
8. Amendment of Protected Health Information.
a. PUSD Request. Within five (5) business days of receiving a request from PUSD to amend an individual’s
PHI received from PUSD, Associate will provide such information to PUSD for amendment. Alternatively,
if PUSD request includes specific information to be included in the PHI as an amendment, Associate will
incorporate such amendment within five (5) business days of receipt of the PUSD request.
b. Individual Request. If an individual makes a request for amendment directly to Associate, Associate will
forward within five business days such request in writing to PUSD. PUSD will be responsible for making
all determinations regarding amendments to PHI and Associate will make no such determinations.
9. Accounting of Disclosures; Requests for Disclosure.
a. Disclosure Records. Associate will keep a record of any disclosure of PHI received from PUSD that
Associate makes to its employees, subcontractors, and agents, or other third parties other than:
(1) Disclosures to health care providers to assist in the treatment of patients;
(2) Disclosures to others to assist PUSD in paying claims;
Business Associate Agreement 4
Revised 06/22/2015

(3) Disclosures to others to assist PUSD in conducting its health care operations, as defined in 45
C.F.R. § 164.501; or
(4) Disclosures made pursuant to an individual’s Authorization.
Associate will maintain this disclosure record for six (6) years from the termination of this Agreement.
Associate also agrees to maintain necessary and sufficient documentation of Disclosures of Protected Health
Information as would be required for PUSD to respond to a request by an individual for an accounting of
Disclosures, in accordance with 45 CFR 164.528.
b. Data Regarding Disclosures. For each disclosure for which it is required to keep a record under
paragraph 8(a), Associate will record and maintain the following information:
(1) The date of disclosure;
(2) The name of the entity or person who received the PHI, and, the address of such entity or person, if
known.
(3) A description of the PHI disclosed; and
(4) A brief statement of the purpose of the disclosure.
c. Provision to PUSD. Associate will provide to PUSD its record of disclosures under paragraph 8(a), if
any, within thirty days of each disclosure. Within five business days of receiving a notice from PUSD of
an individual’s request for an accounting, Associate also will provide to PUSD its disclosure record.
d. Patient Request to Associate. If a Patient requests and accounting of disclosures directly from
Associate, Associate will forward the request to PUSD within five (5) business days of Associate’s receipt
of the request, and will make its records of disclosures available to PUSD as otherwise provided in this
Section. PUSD will be responsible to prepare and for delivery of the records of disclosure to the Patient.
Associate will not provide an accounting of its disclosure directly to the Individual.
10. Notice of Privacy Practices. PUSD shall provide Associate a copy of its Notice of Privacy Practices (“Notice”)
in accordance with 45 C.F.R. § 164.520 as well as any changes to the Notice. If PUSD’ Notice specifically
affects Associate’s use or disclosure of PHI, PUSD shall inform Associate of the specific limitations. Associate
shall abide by the limitations of PUSD’ Notice that affects its use or disclosure of PHI of which it has been
specifically informed. Any use or disclosure permitted by this Agreement may be amended by changes to
PUSD’ Notice if PUSD specifically informs Associate of the amendment: provided, however, that the amended
Notice shall not affect permitted uses and disclosures on which Associate relied prior to receiving notice of such
amended Notice.
11. Access to Books and Records.
a. PUSD Access. Associate will, within five (5) business days of PUSD written request, make available
during normal business hours at Associate’s offices, all records, books, agreements, policies and
procedures relating to the use or disclosure of PHI received from PUSD for the purpose of allowing PUSD
or its agents or auditors to determine Associate’s compliance with this Agreement.
b. Government Access. Associate will make its internal practices, books, and records relating to the use
and disclosure of PHI received from, or created or received by Associate on behalf of, PUSD available to
the Secretary of the Department of Health and Human Services to the extent required for determining
compliance with the Privacy Standards. Notwithstanding this provision, no attorney-client, accountant-
client or other legal privilege will be deemed waived by Associate or PUSD as a result of this Section.
12. Termination. PUSD may immediately terminate the Contract, if any and this Agreement upon written notice to
Associate if PUSD determines that the Associate or subcontractor(s) or agent(s) of Associate has breached a
material term of this Agreement. Alternatively, PUSD may elect to provide Associate with written notice of
Associate’s or subcontractor(s)’ or agent(s)’ of Associate breach of any term or condition of this Agreement and
Business Associate Agreement 5
Revised 06/22/2015

afford Associate the opportunity to cure the breach to the satisfaction of PUSD within thirty (30) days of the date
of such notice. If Associate fails to timely cure the breach, as determined by PUSD at its sole discretion, PUSD
may terminate the Contract and this Agreement.
13. Return or Destruction of Protect Health Information.
a. Return of PHI; Destruction. Within thirty (30) days of termination of the Contract or this Agreement,
Associate will return to PUSD all PHI received from PUSD or created or received by Associate on behalf
of PUSD that Associate maintains in any form or format. Associate will not maintain or keep in any form or
format any portion of such PHI. Alternatively, Associate may, upon PUSD written consent, destroy all
such PHI and provide written documentation of such destruction. The requirement to return or destroy
such PHI will apply to all agents or subcontractors of Associate. Associate will be responsible for
recovering any PHI from such agents or subcontractors. If Associate cannot obtain the PHI from any
agent or subcontractor, Associate will so notify PUSD and will require that such agents or subcontractors
directly return PHI to PUSD or otherwise destroy such PHI, subject to the terms of this Section.
b. Alternative Measures. If Associate believes that returning or destroying PHI at the termination of the
Contract or this Agreement is infeasible, it will provide written notice to PUSD within five (5) business
days of the effective date of termination of this Agreement. Such notice will set forth the circumstances
that Associate believes makes the return or destruction of PHI infeasible and the alternative measures
that Associate recommends for assuring the continued confidentiality and security of the PHI. PUSD
promptly will notify Associate of whether it agrees that the return or destruction of PHI is infeasible. If
PUSD agrees that return or destruction of PHI is infeasible, Associate agrees to extend all protections,
limitations and restrictions of this Agreement to Associate’s use or disclosure of PHI retained after
termination of this Agreement and to limit further uses or disclosures to those purposes that make the
return or destruction of the PHI infeasible. Any such extended protections, limitations and restrictions will
apply to any agents or subcontractors of Associate for whom return or destruction of PHI is determined by
PUSD to be infeasible. If PUSD does not agree that the return or destruction of PHI from Associate or its
agents or subcontractors is infeasible, PUSD will provide Associate with written notice of its decision, and
Associate, its agents and subcontractors will proceed with the return or destruction of the PHI pursuant to
the terms of this Section within fifteen (15) days of the date of PUSD notice.
14. Restrictions on Use or Disclosure of Protected Health Information. If PUSD advises Associate of any
changes in, or restrictions to, the permitted use or disclosure of PHI received from PUSD, Associate will restrict
the use or disclosure of such PHI consistent with the PUSD instructions.
15. Mitigation Procedures. Associate agrees to have procedures in place for mitigating, to the maximum extent
practicable, any deleterious effect from the use or disclosure of PHI received from PUSD in a manner contrary
to this Agreement or the Privacy Standards.
16. Compliance with the HITECH Act. Associate will comply with the requirements of Title XII, Subtitle D of the
Health Information Technology for Economic and Clinical Health (HITECH) Act, codified at 42 U.S.C. §§ 17921-
17954, which are applicable to Associates, and will comply with all regulations issued by the Department of
Health and Human Services (HHS) to implement these referenced statutes, as of the date by which Associates
are required to comply with such referenced statutes and HHS regulations.
a. Associate will also comply with Section 13402 of the HITECH Act, codified at 42 U.S.C. § 17932, and
with all regulations issued by HHS to implement this statute, as of the date by which Associates are
required to comply with such referenced statutes and HHS regulations. Associate will make a report to
the PUSD of any breach of unsecured protected health information, as required by 42 U.S.C. § 17932(b),
within five (5) business days of Associate’s discovery of the breach. Associate will indemnify PUSD for
any reasonable expenses PUSD incurs in notifying individuals of a breach caused by Associate or its
subcontractors or agents.
Business Associate Agreement 6
Revised 06/22/2015

17. Miscellaneous.
a. Compliance with Laws. The Parties acknowledge that state and federal laws relating to electronic data
security and privacy are rapidly evolving and that amendment of this Agreement may be required to
ensure compliance with such developments. Should such developments occur, and upon either Party’s
good faith request, the other Party agrees to enter good faith negotiations concerning the terms of an
amendment to this Agreement.
b. Construction of Terms. The terms of this Agreement will be construed in light of any applicable
interpretation or guidance on the Privacy Standards and Security Standards issued by the Department of
Health and Human Services and other applicable state or federal laws, rules and regulations as amended
from time to time.
c. No Third Party Beneficiaries. Nothing in this Agreement will confer upon any person other than the
parties and their respective successors or assigns, any rights, remedies, obligations, or liabilities,
whatsoever.
d. Assignment of Rights and Delegation of Duties. This Agreement is binding upon and inures to the
benefit of the Parties hereto and their respective successors and permitted assigns. However, neither
Party may assign any of its rights or delegate any of its obligations under this Agreement without prior
written consent of the other Party, which consent shall not be unreasonable withheld or delayed.
Notwithstanding any provisions to the contrary, however, PUSD retains the right to assign or delegate any
of its rights and obligations hereunder to any of its wholly owned subsidiaries, affiliates or successor
companies. Assignments made in violation of this provision are null and void.
e. No Waiver. Failure or delay on the part of either Party to exercise any right, power, privilege or remedy
hereunder shall not constitute a waiver thereof. No provision of this Agreement may be waiver by either
Party except by a writing signed by an authorized representative of the Party making the waiver.
f. Severability. The provisions of this Agreement shall be severable, and if any provision of this Agreement
shall be held or declared to be illegal, invalid or unenforceable, the remainder of this Agreement shall
continue in full force and effect as though such illegal, invalid or unenforceable provision had not been
contained herein.
g. Entire Agreement. This Agreement constitutes the entire agreement between the parties with regard to
the Privacy Standards and Security Standards, there are no understandings or agreements relating to this
Agreement that are not fully expressed in this Agreement and no change, waiver or discharge of
obligations arising under this Agreement will be valid unless in writing and executed by the party against
whom such change, waiver or discharge is sought to be enforced.
h. Written Agreement. This Agreement is considered as an integral part of the underlying Contract, and is
incorporated as though fully set forth within the Contract. This Agreement will govern in the event of
conflict or inconsistency with any provision of Contract.
i. Choice of Law. This Agreement and the rights and obligations of the parties hereunder shall be
governed by and construed under the laws of the State of Arizona, without regard to applicable conflict of
law principles.
j. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be
deemed an original and when taken together shall constitute one agreement.
k. Facsimile and Electronic Signatures. Facsimile and electronic signatures shall be deemed to be
original signatures for all purposes of this Agreement.
l. Notices. Any notices required under this Agreement will be sent to the parties at the following address
by first class mail, fax or hand delivery:
Business Associate Agreement 7
Revised 06/22/2015

PUSD MARICOPA COUNTY (‘Associate’) through its
Peoria Unified School District Department of Public Health
6330 West Thunderbird Road 4041 N. Central Avenue, Suite 1400
Glendale, AZ 85306 Phoenix, AZ 85012
Phone: (602) 486-6066 Fax: (602) 506-6885
Agreed to by PUSD and Associate by:
PUSD MARICOPA COUNTY (ASSOCIATE)
______________________________________ _____________________________________
SIGNATURE DATE SIGNATURE DATE
Steve Chucri, Chairman, Board of Supervisors
PRINT NAME AND TITLE PRINT NAME AND TITLE
ATTEST”
_____________________________________
Clerk of the Board Date
APPROVED AS TO FORM”
_____________________________________
Attorney for Maricopa County Date
Business Associate Agreement 8
Revised 06/22/2015

Peoria Unified School District
6330 West Thunderbird Road
Glendale, AZ 85306
(602) 486-6066
BUSINESS ASSOCIATE AGREEMENT
FOR RELEASE OF INFORMATION TO THIRD PARTIES
1. _______________________________ (“Associate”) is a business associate of Peoria Unified School
District (PUSD) pursuant to the Agreement between Associate and PUSD dated __________
(“Agreement”). Pursuant to that Agreement, Associate is required to comply with the requirements for the
use and handling of Protected Health Information (“PHI”) from PUSD as set forth in the Standards for
Privacy of Individually Identifiable Health Information, 45 C.F.R. 164.501 et. seq. as amended from time to
time (“Privacy Standards”).
2. Associate is permitted to disclose PHI to _______________ (“Recipient”) for the necessary management
and administration of Associate and to carry out the legal responsibilities of the Associate, provided that
Recipient provides Associate with the following assurances for Recipient’s use and disclosure of PHI.
3. Associate seeks to disclose PHI to Recipient for the following management, administration or legal
responsibilities of Associate:
4. The disclosure of PHI to Recipient is conditioned upon Recipient’s assurance that, and Recipient agrees
that it will:
a. Hold the PHI confidentially and make no re-disclosure to any third party without Associate’s express
advance written consent;
b. Use or disclose the PHI only as required by law or for the purposes set forth above; and
c. Notify Associate in writing of any breaches in the confidentiality of the PHI within three days of
discovery of any such breach.
ASSOCIATE RECIPIENT
_____________________________________ _______________________________
SIGNATURE DATE SIGNATURE DATE
_____________________________________ ________________________________
PRINT NAME AND TITLE. PRINT NAME AND TITLE
Business Associate Agreement 9
Revised 06/22/2015