Ulta Lab Tests, LLC / FM Software, LLC Authorization Agreement

FOR The Weatherby Group, LLC Subscribers:

Pursuant to the terms of your arrangement with The Weatherby Group, LLC, you have directed Ulta Lab Tests, LLC to release all laboratory test results to The Weatherby Group, LLC which is acting on your behalf as your “Business Associate” as that term is defined in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). The Weatherby Group, LLC will receive and make available, online, all the results from all of the tests that you order from Ulta Lab Tests, LLC at https://my.bloodchemsoftware.com.

By executing this document, you authorize such a disclosure of test results to FMSoftware LLC, and you represent and warrant that if required, you have obtained any appropriate consent forms or authorizations required by your patients for whom you have ordered laboratory testing. You must agree to the guidelines as explained in this document, for us to begin transmitting.

You represent that you have the authority to agree to these terms on behalf of the Client, and acknowledges that Client is responsible for maintaining the security and confidentiality of the reports that are made available in their Functional Blood Chemistry Analysis Software Account located at https://my.bloodchemsoftware.com.

This agreement will be effective as per the date you click “I Agree”. If at any time you are not a current subscriber to The Weatherby Group, LLC you understand that it is your responsibility to notify Ulta Lab Tests, LLC of this change.