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2013 Omnibus Rule Business Associate Agreement

As a Business Associate/Vendor, you may have recently received a letter from St. Luke’s asking you to complete and return the following revised BAA St. Luke’s has with you. If so, please download the Revised Omnibus Agreement Template and follow these instructions:

  1. On Page 1, select the correct St. Luke’s Entity that your contract is with using the “Choose an item” from your current BAA with St. Luke’s. Please refer to your existing contract with us to ensure you have selected the correct location.
  2. On Page 1, fill in the “Click here to insert business associate name including type of applicable corporation (Inc., Ltd, LLC, etc.)” with your organization’s full legal name or the person’s name that is providing services to St. Luke’s.
  3. On Page 1, fill in the “Click here to insert State of incorporation and profit/nonprofit status (Idaho nonprofit or for profit corporation, etc.)”.
  4. On Page 1, fill in your company’s principal office address at “Click here to insert street, city, state, zip”.
  5. On Page 1, in Background section, fill in “Choose an item” to select the services your organization or person will be doing on behalf of St. Luke’s.
  6. On Page 6, under clause 18, fill in the current date as the Effective Date.
  7. On Page 6, fill in the Business Associate signature block information and the Operational Contact.
    • Sign (your electronic signature will be accepted as the original)
    • Print name
    • Print title
    • Email address
    • Phone number
    • Fax number
    • Web Site URL
    • Date
  8. Scan and return the BAA to Nancy T. Harris at harrisna@slhs.org.

If you prefer, you may print, complete and sign the revised BAA in pen. If you do so, please return a copy by mail to St. Luke’s Health System, 190 E. Bannock Street, Boise, ID, 83712, attention Nancy T. Harris, or send a faxed copy to (208) 493-0572. For any questions, contact Nancy Harris at (208) 493-2496.