I authorize my physician or other provider (“Provider”) to record the audio of my interactions with the Provider using the recording tool provided by Modernizing Medicine, Inc. (the “Company”). I understand that the Company will record and access such recordings for purposes of the development and improvement of Company technology that may be used to help improve clinical documentation and physician practice management.

Information to be Used and Disclosed: All audio information heard or recorded in connection with or during my interaction(s) or visit(s) with my Provider from January 1, 2024 through December 31, 2024 (“Provider Interactions”), including without limitation, conversations, sounds, audiotapes, and/or verbal statements made during the Provider Interactions by anyone present, and my demographic, biographical, and medical information (including any and all clinical documentation) related to such Provider Interactions.

Persons Authorized to Receive Information: (1) Any and all persons present at the Provider Interactions, (2) anyone employed by or affiliated with Company who, for purposes of development and improvement of Company technology, listens to the recording of the Provider Interaction after it is recorded or reviews a transcript of the recording or associated clinical documentation, and (3) anyone the Company may hire or contract with to capture, transcribe, edit, aggregate, or modify the recording or transcript or to assist in development of the product(s).

Purposes: For development and improvement of Company technology that may be used to help improve clinical documentation and physician practice management. I understand and agree that Company will store my information in its audio-recorded format for a maximum period of six (6) months. I further understand and agree that Company will create a transcript of the recording to be retained for a maximum period of six (6) months from the date of the Provider Interaction that was recorded. I understand and agree that no later than six (6) months after the date of the recorded Provider Interaction, the Company will destroy the recording and will use third-party technology and/or tools designed to remove content from the transcript that may identify me and that Company will retain such modified transcript for as long as the Company so chooses.

Right to Revoke: Except to the extent that action has already been taken in reliance on this authorization, at any time I can revoke this authorization by submitting an email to Company at ambientlistening@modmed.com, or (if revoking during the Provider Interaction), by informing my provider. Unless revoked, this authorization will expire on December 31, 2024. After expiration or revocation of this authorization, the Company may continue to use and disclose any modified transcripts created from Provider Interactions that occurred before I revoked consent. The Company may destroy or dispose of recordings and transcripts at any time without notice to me.

Re-disclosure/Voluntary Consent: I understand the information disclosed by this authorization may be subject to re-disclosure by anyone receiving it, and the information disclosed will no longer be protected by federal privacy laws and regulations. This authorization is voluntary. I understand that neither the Company nor my provider may condition treatment, payment, enrollment, or eligibility for benefits on whether I sign this authorization form.