ࡱ> IKH )bjbjo>o> 4@ T T V ,,@,@@@8x,4@('''''''$)d,',6$',,'L,,''V%@&DU'e;& {''0(G&T:-:-&:-H&"''(:- : DATA USE AGREEMENT This Data Use Agreement (Agreement) is made and entered into as of this ________________ day of ____________, 20__ (the Effective Date) by and between ___________________________ with an address at ______________(Covered Entity), and pro, a Missouri benevolent corporation with an address at 221 North Grand Boulevard, St. Louis, MO 63103 (Data Recipient). WITNESSETH: WHEREAS, Covered Entity may Disclose or make available to Data Recipient, and Data Recipient may Use, Disclose, receive, transmit, maintain or create from, certain information in conjunction with research; and WHEREAS, Covered Entity and Data Recipient are committed to compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and regulations promulgated thereunder; and WHEREAS, the purpose of this Agreement is to satisfy the obligations of Covered Entity under HIPAA and to ensure the integrity and confidentiality of certain information Disclosed or made available to Data Recipient and certain information that Data Recipient Uses, Discloses, receives, transmits, maintains or creates, from Covered Entity. WHEREAS, Data Recipient agrees to limit its use of the Limited Data Set and protect the Limited Data Set in accordance with the terms of this Agreement and the HIPAA Privacy and Security Rules. THEREFORE, in consideration of the mutual agreements, terms and conditions herein contained, Covered Entity and Data Recipient agree as follows: A. DEFINITIONS Terms used but not otherwise defined in this Agreement, including without limitation Use and Disclose, shall have the same meaning as those terms in the Privacy Rule. 1. Individual shall have the same meaning as the term individual in 45 CFR Sect. 164.501 of the Privacy Rule and shall include a person who qualifies as a personal representative in accordance with 45 CFR Sect. 164.502(g) of the Privacy Rule. 2. Limited Data Set shall have the same meaning as the term limited data set in 45 CFR 164.514(e) of the Privacy Rule. 3. Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Information at 45 CFR Part 160 and Part 164, Subparts A and E, as amended from time to time. 4. Protected Health Information or PHI shall have the same meaning as the term protected health information in 45 CFR Sect. 164.501 of the Privacy Rule, to the extent such information is created or received by Data Recipient from Covered Entity. 5. Required by Law shall have the same meaning as the term required by law in 45 CFR Sect. 164.501 of the Privacy Rule. B. SCOPE AND PURPOSE 1. This Agreement sets forth the terms and conditions pursuant to which Covered Entity will Disclose certain PHI to the Data Recipient. 2. Except as otherwise specified herein, Data Recipient may make all Uses and Disclosures of the Limited Data Set necessary to conduct the research described herein: _______________(include a brief description of the research project)_____________________________ (Research Project). 3. For purposes of this Agreement, Recipients primary representative for receipt, Use and Disclosure of the Data for the Purpose shall be:___________________________________ C. OBLIGATIONS AND ACTIVITIES OF DATA RECIPIENT 1. Data Recipient agrees to not Use or Disclose the Limited Data Set for any purpose other than the Research Project or as Required by Law. 2. Data Recipient agrees to use appropriate safeguards to prevent Use or Disclosure of the Limited Data Set other than as provided for by this Agreement. 3. Data Recipient agrees to promptly report to the Covered Entity any Use or Disclosure of the Limited Data Set not provided for by this Agreement of which it becomes aware. 4. Data Recipient agrees to ensure that any agent to whom it provides the Limited Data Set agrees to the same restrictions and conditions that apply through this Agreement to the Data Recipient with respect to such information. 5. Data Recipient agrees not to identify the information contained in the Limited Data Set or contact the individual. 6. Data Recipient agrees to share the results of the Research Project (Results) with Covered Entity. Covered Entitys use of the Results shall be limited to its internal, non-commercial, research purposes only. D. TERM AND TERMINATION The Term of this Agreement shall be from the Effective Date until ______________. Upon Covered Entitys knowledge of a material breach by Data Recipient, Covered Entity shall have the right to immediately terminate this Agreement. (a) Except as provided in paragraph (b) of this subsection, upon termination of this Agreement or upon request of Covered Entity, whichever occurs first, Data Recipient shall return or destroy the Limited Data Set received from Covered Entity. (b) In the event that Data Recipient determines that returning or destroying the Limited Data Set is not feasible, Data Recipient shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the parties that return or destruction of the Limited Data Set is infeasible, Data Recipient shall extend the protections of this Agreement to such Limited Data Set and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Data Recipient maintains such Limited Data Set. E. OWNERSHIP The Covered Entity shall retain ownership of all data transferred by it to the Data Recipient under this Agreement. Nothing in this Agreement shall be construed to confer or grant any commercial rights or license to any patentable intellectual property that may arise from use of the data or to any patentable intellectual property owned or created by the Covered Entity. The Data Recipient shall retain ownership of the Results. Nothing in this Agreement shall be construed to confer or grant any commercial rights or license to any patentable intellectual property that may arise from use of the data or to any patentable intellectual property owned or created by the Data Recipient. F. MISCELLANEOUS 1. A reference in this Agreement to a section in the Privacy Rule means the section as amended or as renumbered. 2. The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and HIPAA. 3. The respective rights and obligations of Data Recipient under Section C of this Agreement shall survive termination of this Agreement. 4. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule. 5. There are no intended third party beneficiaries to this Agreement. Without in any way limiting the foregoing, it is the parties specific intent that nothing contained in this Agreement gives rise to any right or cause of action, contractual or otherwise, in or on behalf of the individuals whose PHI is Used or Disclosed pursuant to this Agreement. 6. No provision of this Agreement may be waived except by an agreement in writing signed by the waiving party. A waiver of any term or provision shall not be construed as a waiver of any other term or provision. 7. The persons signing below have the right and authority to execute this Agreement and no further approvals are necessary to create a binding agreement. 8. In the event of any conflict between the terms and conditions stated within this Agreement and those contained within any other agreement or understanding between the parties, written, oral or implied, the terms of this Agreement shall govern. Without limiting the foregoing, no provision of any other agreement or understanding between the parties limiting the liability of Data Recipient to Covered Entity shall apply to the breach of any covenant in this Agreement by Data Recipient. 9. This Agreement shall be construed in accordance with and governed by the laws of the State of Missouri. IN WITNESS WHEREOF, the parties have executed this Agreement effective upon the Effective Date set forth above. COVERED ENTITY: DATA RECIPIENT: pro ______________________________ Name: Name: Title: Title:     {00044726-1} Data use agreement incoming OGC approved 2016 Insert description of use here Name of PI here PI to confirm interest in sharing the data before sending to the other party Length of time needed for use of data `px 1Je)AX— *hMR+hMR+jhI 0JU *hMR+hMR+>* *hMR+hR>* hR>*hMR+h hZhh]? hR5\ hI hI hI hC *hUCh\h J *hUChRhR; w x ; < V W $a$gdZ$a$$a$?@VW)*$a$gdC$`a$$a$;D)-[o @]^_mopqzl[!hMR+hMR+B* OJQJ^Jph *hMR+hMR+OJQJ^JjhI 0JOJQJU^Jh}Zh}ZOJQJ^JhMR+OJQJ^J *hnWhROJQJ^J!hMR+hR5>*OJQJ\^JhMR+hR5OJQJ\^JhRCJaJjhI 0JUhMR+ h Jh Jh J hR5\hChRqrz{}? $`a$gd J$a$gd J$a$gd}Zgd}ZgdMR+ $^a$gdMR+$ & F^`a$gdMR+$a$$`a$$`a$qr%t  VdJXyz|}~> ? @ A R ƹƹйййййƯ~tgZtZhR5OJQJ\^JhI 5OJQJ\^JhROJQJ^Jh Jh J5OJQJ^Jh J5OJQJ^JhI 5OJQJ^Jh Jh JOJQJ^Jh JOJQJ^Jh}Zh}ZOJQJ^Jh}ZOJQJ^JhMR+OJQJ^Jhh]?OJQJ^JhMR+h}ZOJQJ^JhMR+B* OJQJ^Jph#? @ Q R !!""""##$$i%j%X'Y''''''''$`a$$a$$`a$$a$ #''B(D(R(S(W(e(f(h(((((((((((((((((((((((((((((((((((̿򨟛y"hI hI <CJaJmHnHuhy hI jh7WUh7Wh7WmHnHujh7WUmHnHuhf hR>*hfhROJQJ^Jh\OJQJ^Jh !_OJQJ^J hR5\ hf5\h/hRhROJQJ^J-'''''A(B(C(D(g(h((((((((((((((((( $`a$gdgd !_$a$((((((((6)7)8)9):);)<)=)])n))))) $`a$gdgdh]?())))$)4)5)6)7)8)9):);)<)=)>)])^)n)o))))))·¬hRjhI 0JUh7Why hI hJ3{ hh]?hRhh]?h;KCJaJhh]?hh]?CJaJhI CJaJhh]?h JCJaJhh]?CJaJ"hI hI <CJaJmHnHuhI hI CJaJmHnHu21h:pf/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH R`R ANormal7$8$$CJOJQJ^J_HaJmH sH tH >@> A Heading 1 $@&a$5\DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List 4>@4 ATitlea$ 5>*\2B@2 A Body Texta$>P> A Body Text 2 ^p`0a$4 @"4 AFooter !2)`12 A Page Number^JF+@BF A Endnote Text1$H$ OJQJ^J:U`Q:  Hyperlink>*B*^Jph4@b4 ;KHeader !<@r< }Z List Paragraph^B'`B I Comment ReferenceCJaJ<@< I Comment TextCJaJFoF I Comment Text Char OJQJ^J@j@@ I Comment Subject5\RoR I Comment Subject Char5OJQJ\^JH@H I Balloon TextCJOJQJ^JaJNoN I Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] burkhardt ]!bzbzbzb zBBBB 1!@ QSUXq ()? '()L# @0(  B S  ? r r!!9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace 0P  zzz z -X  ] ?ABCDEFGJRoot Entry F'L1Table!R-WordDocument4@SummaryInformation(8DocumentSummaryInformation8@CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q