As you know, we have accepted your letter of protection regarding our interest in your client(s). Regarding your client(s)’/our patient(s)’ claim against the responsible third parties arising from the incident/accident. Please consider this formal notice that upon our acceptance of your letter of protection and our providing your client(s) with the requested medical services that you agree to keep us informed of the status of the matter on a periodic basis. You further agree to promptly forward payment to us upon your receipt of funds on the matter either by way of settlement or judgment. Your failure to keep us informed of the status of this matter as agreed will result in the withholding of any further medical service/treatment, the filing of any and all appropriate medical liens and/or litigation to protect our interests.

WHEREAS, Texas Department of Health (Covered Entity) and the Contractor (Business Associate), intend to protect the privacy and provide for the security of certain Protected Health Information (PHI) to which Business Associate may have access in order to provide goods or services to or on behalf of Covered Entity, in accordance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, Public Law 111-5, the HIPAA Privacy Rule (Privacy Rule) modifying 45 CFR Parts 160 and 164, and the HIPAA Security Rule (Security Rule), modifying 45 CFR Parts 160, 162 and 164.

WHEREAS, Business Associate may receive PHI in any format including electronic form, from Covered Entity, or may create or obtain PHI from other parties for use on behalf of Covered Entity, which PHI must be handled, disclosed or used only in accordance with this Agreement, and the standards established by the HIPAA Rules.