KAISER PERMANENTEKaiser Permanente • August 5th, 2014
KAISER PERMANENTE (“KP”) ALL-PURPOSE Release and Consent AgreementKaiser Permanente • October 6th, 2015
I, (print name), in exchange for valuable consideration* received, hereby irrevocably consent to the unrestricted use for or by Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, the Permanente Medical Groups, and each of their affiliates and subsidiaries and their respective directors, officers, employees, agents, customers, successors and assigns (collectively “KP”) of the following (mark below only those items that you are releasing):
Release and Consent Agreement – For Photos, Audio, Name, and Creative Works (INCLUDES HIPAA AUTHORIZATION: Use This 3-page Form Where Member/Patient Health Information Will Be Disclosed)Kaiser Permanente • November 6th, 2020
I, ____________________________________ (print name), in exchange for valuable consideration* received, hereby irrevocably consent to the unrestricted use for or by Kaiser Foundation Health Plan, Inc. (“KFHP”), Kaiser Foundation Hospitals (“KFH”), the Permanente Medical Groups, and each of their affiliates and subsidiaries and their respective directors, officers, employees, agents, customers, successors and assigns (collectively “KP”) of the following (mark below only those items that you are releasing):
Kaiser Permanente® Business Associate AgreementKaiser Permanente • June 25th, 2020
THIS BUSINESS ASSOCIATE AGREEMENT (“BAA”) SHALL APPLY TO ANY SUPPLIER THAT HAS A BUSINESS RELATIONSHIP (AS DEFINED BELOW) WITH KP THAT INVOLVES THE RECEIPT, CREATION, MAINTENANCE, ACCESS, TRANSMISSION, USE AND/OR DISCLOSURE OF PHI (AS DEFINED BELOW) TO THE EXTENT THE SUPPLIER QUALIFIES AS A BUSINESS ASSOCIATE UNDER HIPAA REGULATIONS. THIS AGREEMENT APPLIES UNLESS SUPPLIER AND KP HAVE A SEPARATELY SIGNED BUSINESS ASSOCIATE AGREEMENT.
