Athenahealth Authorization and Consent Form

This authorization and consent form relates to the use or disclosure of Client’s (i) "protected health information" or "PHI" as that term is used under the Health Insurance Portability and Accountability Act of 1996, and associated regulations ("HIPAA"), and (ii) all data and information (including confidential information) provided by or on behalf of Client or its Authorized Users to Athena (all such data and information, together with PHI, "Data") under the services agreement (the "Agreement") between athenahealth, Inc. ("athenahealth") and the client indicated below ("Client").

Notwithstanding anything in the Agreement to the contrary, Client requests and hereby authorizes athenahealth to enable the exchange of Data between athenaNet and the third-party partner referenced in this Authorization and Consent Form ("Partner"). Client represents and warrants that (i) any such exchange of Data complies with applicable law; (ii) Client has all necessary consents to authorize such exchange of Data; and (iii) Client and Partner are subject to any agreements required by applicable law (which may include a business associate agreement).