Consent to Share Data, including Patient Information between MatrixCare and the Partner Company is the company proposing this Authorization. Company has built an Integration to be able to populate data from your database(s) and/or from a static copy of your database(s) (including all facilities in an enterprise account) in the MatrixCare, Inc. ("MC") Solution that is updated from time to time, and, if applicable, bidirectionally. It is our policy to obtain consent from each of our customers before we allow their data to be shared with another company or party. We have a Business Associate Agreement in place with you, and we have been informed by MC that they also have a Business Associate Agreement in place with you for the protection of that information.
Please complete all the fields below and submit this Authorization form authorizing us to exchange data between MC and Company.
By submitting this Authorization, I, as a duly authorized representative of the Client/Customer, hereby grant my consent to the passage of data between the MC Solution and the Company Solution and represent and warrant that Customer is legally free to enter into this Authorization.
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