Data Sharing Authorization

Data Sharing Authorization

This Data Sharing Authorization (this “Authorization”), effective as of the date of electronic signature by Facility (“Effective Date”), is between Healthcare Systems & Technologies, LLC (“HST”), and the Facility that agrees to the terms herein by affixing its electronic signature hereto (“Facility,” and together with HST, the “Parties”).

Recitals

1. HST desires to share the Facility’s scheduled patient information with its anesthesia provider (“Provider”), or their representative billing service, for the purpose of calculating and presenting a cost estimate to the patient and notifying the Provider of the upcoming cases.
2. To facilitate Provider’s access to such patient information, Provider desires Facility to allow HST to electronically access scheduled patient data (the “Data Extract”) from Facility’s practice management system and deliver it to Provider.

The Parties hereby agree as follows:

Agreement

1. Data Sharing. Facility agrees to share with HST, via the Data Extract, the basic demographics, insurance coverage, schedule, and procedure information associated with patients who will be cared for by Provider, and further agrees that HST may share such information with Provider.
2. Fees. There are no fees due or payable under this Authorization.
3. Data Extract Build. HST will build the Data Extract and Facility agrees to provide assistance as reasonably requested by HST. The Data Extract will be implemented in accordance with HST’s specifications.
4. PHI; Business Associate Agreement. Facility acknowledges that the Data Extract will include protected health information (“PHI”). The sharing of such PHI will be subject to the terms of the Business Associate Agreement between Facility and HST; provided, that if HST and Facility do not have an existing Business Associate Agreement in place, HST will be operating as a subcontractor of Provider and the sharing of PHI with HST will be covered under the Business Associate Agreement between Provider and Facility.
5. Limitations of Liability. IN NO EVENT WILL HST BE LIABLE UNDER OR IN CONNECTION WITH THIS AUTHORIZATION UNDER ANY LEGAL OR EQUITABLE THEORY, INCLUDING BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, AND OTHERWISE, FOR ANY CONSEQUENTIAL, INCIDENTAL, INDIRECT, EXEMPLARY, SPECIAL, ENHANCED, OR PUNITIVE DAMAGES, REGARDLESS OF WHETHER HST WAS ADVISED OF THE POSSIBILITY OF SUCH LOSSES OR DAMAGES OR SUCH LOSSES OR DAMAGES WERE OTHERWISE FORESEEABLE. IN NO EVENT WILL HST’S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AUTHORIZATION, UNDER ANY LEGAL OR EQUITABLE THEORY, INCLUDING BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, AND OTHERWISE, EXCEED $10,000.
6. Term and Termination. The term of this Authorization begins on the Effective Date and, unless terminated by either party upon 30 days’ written notice, will continue in effect for as long as Facility or Provider is a customer of HST (the “Term”).
7. Electronic Signatures. Each party agrees that this Authorization and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this Authorization or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.