Please email this completed User Agreement to EnrollmentAdmin@OﬃceAlly.com or fax to (360) 314-2184.
For questions call (360) 975-7000 opt. 3.
ELECTRONIC HEALTH RECORDS (EHR 24/7™) USER AGREEMENT
This Agreement is made by and between ________________________________________ (Practice/Facility
name on Oﬃce Ally Account), and Oﬃce Ally, Inc. ("Oﬃce Ally").
WHEREAS, User and Oﬃce Ally have entered into an Agreement with a separate Enrollment Form/Authorization Sheet for services including the
storage and maintenance of Protected Health Information generated by User (collectively, the “Service Agreements”); and
WHEREAS, User desires Oﬃce Ally to incorporate third-party medical reports ordered by and/or provided to User into patient medical records maintained
by Oﬃce Ally for User under the Service Agreements.
NOW, THEREFORE, in consideration of the mutual covenants and conditions herein contained, the parties hereto agree as follows:
The terms and conditions of the Service Agreements are hereby incorporated into this Agreement. All terms and deﬁnitions therein shall have the
same meaning in this Agreement, unless otherwise provided herein.
1. INCORPORATION OF SERVICE AGREEMENTS
User hereby authorizes Oﬃce Ally to incorporate Medical Reports related to a patient of User into such patient’s medical records maintained by
Oﬃce Ally on behalf of User under the Service Agreements. For purposes of this Agreement, “Medical Reports” shall mean any reports generated
by outside consultants of User engaged to perform medical or medical related testing or examination on or of such patient, and provided by User
to Oﬃce Ally. In performing such service, Oﬃce Ally shall protect and preserve the conﬁdentiality of such Medical Reports and any other Protected
Health Information (“PHI”) received by Oﬃce Ally in conjunction therewith as is more speciﬁcally provided for in the Service Agreements, and subject
to the terms and conditions thereof.
2. AUTHORIZATION TO INCORPORATE MEDICAL REPORTS
For the rendering of the services provided for herein, User shall pay Oﬃce Ally fees of $29.95* per month, per provider (including nurse practitioners
& physician assistants). All fees are due in advance of the ﬁrst full month of service. Once Oﬃce Ally receives this Agreement the User will be sent
an invoice for the ﬁrst full month’s fee of $29.95* per month, per provider (including nurse practitioners & physician assistants). All fees are due and
payable before the 1st day of the ﬁrst full month of service. See Customer Authorization Recurring Auto Payment Form for automatic payments to
avoid disruption of service. No refunds will be issued for mid-month cancellations or advance payments. Account disruption due to nonpayment is
not to be considered the cancellation of EHR 24/7 and is independent of the following cancellation of services policy.
3. FEE FOR SERVICES
User designates Oﬃce Ally to manage security controls using industry standards and HIPAA best practices to include but not limited to: unique user ids,
password complexity, minimum password length, limiting password reuse, lock-out parameters, banner notiﬁcation and password expiration notice.
INWITNESS WHEREOF and acknowledging acceptance and agreement of the foregoing, the User shall aﬃx their signature hereto.
6. EHR 24/7 SECURITY REQUIREMENTS
If User wishes to cancel this service it must complete the product cancellation form. Upon request to cancel Oﬃce Ally will send the product cancellation
form to User. User shall not consider the cancellation complete until the time that it has received an email conﬁrmation to the email address on the
account. Cancellation can only be requested by the Oﬃce Ally account owner. Additionally, User acknowledges that any unpaid account balance
must be paid prior to Oﬃce Ally processing the cancellation request and said unpaid balance may delay the processing of the cancellation. Upon
User’s request Oﬃce Ally will create a copy of all medical records contained in User’s account and provide User with a CD containing all data. Oﬃce
Ally will charge User a one-time fee of $39.95* to extract the data. User may elect to extract the data itself at no cost.
4. CANCELLATION OF SERVICES
5. EHR 24/7 SYSTEM REQUIREMENTS
Windows: OS (PC):
Windows 7, or above
Internet Browser Internet Connection:
Internet Explorer version 11 or above, with a 128-bit encryption
Safari version 11.1.2 or above, with 128-bit encryption
Chrome version 58+ or above, with a 128-bit encryption
MAC OS 10.11, or above
Name (President/CEO/Owner of Entity who owns the Oﬃce Ally Account) Signature (President/CEO/Owner of Entity who owns the Oﬃce Ally Account)
Title (President/CEO/Owner of Entity who owns the Oﬃce Ally Account) Practice/Facility Name
Contact Name / Phone Number Oﬃce Ally Representative
Username (If you are a current Oﬃce Ally user)** ACTIVATION DATE. The date entered above is the date your EHR 24/7 account will be activated,
and the date you will start being billed for the service. If left blank it will default to the date this
agreement is received.
*Rates /Terms are subject to change. **If you are not a current Oﬃce Ally user you must complete the enrollment process. OA 2018-08-07
High-Speed internet connection via DSL, cable
modem, or TI line.
Bandwidth to support the number of users in your
oﬃce accessing the internet simultaneously.