The first step in becoming a Certified Consultant

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CCN Application Process

This is the first step in becoming a Certified Consultant. Fill out the form below. Agree to the terms of service and click Send!

Company information

Company name *
Street address 1 *
Street address 2
City *
State *
Zip code *
Company phone *
Company website

Primary contact

First name *
Last name *
Direct phone *
Email *

Briefly answer the questions below

Why is your company interested in joining Practice Fusion's Certified Consultant Network? *

You have 550 characters remaining.

What services does your company provide? *











Who is your target market? *

You have 550 characters remaining.

Do you have a physician network and if so how large? *

You have 550 characters remaining.

Do you have experience in EHR’s or HealthCare? *

You have 550 characters remaining.
What territories (states) do you cover? Please state if National. *























































What will this partnership bring to Practice Fusion's Certified Consultant Network? *

You have 550 characters remaining.

Are you currently or have you previously worked with a Practice Fusion user? If so, please provide their Practice ID. *

You have 550 characters remaining.

How large is your company? How many employees would be promoting Practice Fusion? *

You have 550 characters remaining.

Do you promote other EHR's? If so, which ones? *

You have 550 characters remaining.

When was your company established? *

Please provide at least 2 references that you have previously worked with. *

You have 550 characters remaining.
Terms of service *
Have the Provider sign this form: Download the Consultant-Provider Agreement

LEGAL AGREEMENT



THIS CERTIFIED CONSULTANT NETWORK LEGAL AGREEMENT (this "Agreement"), is made

effective as of the date indicated above (the "Effective Date") between Practice Fusion, Inc., a Delaware

corporation ("Practice Fusion") with a principal place of business at 420 Taylor Street, San Francisco, California

94102 and the Consultant Name and/or Primary Contact named above, a corporation (or other legal entity, as

indicated above) organized under the laws of the state indicated above, having its principal place of business at the

address indicated above ("Consultant").

TO AGREE TO THESE TERMS, CLICK ON "CLICK TO SEND" BELOW. IF YOU DO NOT AGREE TO

THESE TERMS, DO NOT CLICK ON "CLICK TO SEND," AND DO NOT ATTEMPT TO USE THE

CERTIFIED CONSULTANT NETWORK.

1. Definitions

For purposes of this Agreement, the following terms shall have the following meanings:

1.1. "Confidential Information" shall mean any and all nonpublic information that Practice Fusion designates as

confidential, or which, under the circumstances of disclosure ought to be treated as confidential. "Confidential

information" includes, without limitation, trade secrets, proprietary information, techniques, algorithms, and

software programs or information related to the current, future and proposed products and services, information

concerning research, engineering, financial information, procurement requirements, purchasing, manufacturing,

customer lists, business forecasts, business policies or practices, sales and merchandising, and marketing plans and

information.

1.2. "Contact Information" shall mean information on each individual Consultant Practitioner designed to enable

Practice Fusion to contact said practitioner, and shall include practitioner's first name, last name, full business

address, office telephone number, practitioner specific email, practitioner main practice email, and all of the above

information for practitioner's office manager or equivalent.

1.3. "Consultant Practitioner" shall mean any health care practitioner, practice group and/or association of health

care professionals that is authorized under applicable law.

1.4. "Products" shall mean the computer software products, related documentation and services produced or

provided by Practice Fusion, which Practice Fusion may amend from time to time without notice to Consultant.

1.5. "Promotional Material" shall mean any and all materials drafted and/or published by Practice Fusion for

purposes of promoting the business and contractual relationship between Consultant and Practice Fusion.

2. Consultant Licenses

2.1. Demonstration License. Practice Fusion hereby grants Consultant a non-exclusive, nontransferable, royalty-free,

fully revocable license during the term of this Agreement to use the Products for promotion, demonstration and

marketing purposes only, provided that Consultant (i) complies with any applicable provisions of Practice Fusion's

User Agreement located at www.practicefusion.com/pages/user-agreement.html and any applicable terms of the

Practice Fusion Privacy Statement located at http://www.practicefusion.com/pages/privacy_policy.html, each as

may be amended from time to time by Practice Fusion, and (ii) shall not, at any time, use the Products pursuant to

the license granted herein to store, access, use, disclose or display any Individually Identifiable Health Information

or other personal information protected under federal or applicable state law. Practice Fusion otherwise reserves all

rights in and to the intellectual property in the Products.

2.2. License of Trademarks. Consultant agree not to infringe on any proprietary rights (including but not limited to

intellectual property rights), including that of Practice Fusion and other persons or third-party entities. Consultant

hereby agrees not to adopt or use in any manner any trademarks, service marks, trade names, email addresses, and/or Page 2 of 5

042_11232011_PF-CCN.11_2011

uniform resource locators (URLs) that are the same or confusingly similar to, or are combined with, those of

Practice Fusion.

2.3. Prohibited Uses. Consultant will not produce, manufacture or electronically distribute the Products; copy the

Products; disassemble, decompile or reverse engineer the Products; make alterations in or modifications or

enhancements to the Products; or grant licenses, sublicense, leases or other rights in the Products.

2.4. Participation. For purposes of this Agreement only, "Active User" shall be defined as a registered user of

Practice Fusion's Electronic Health Records system ("EHR") that records at least one hundred (100) patient chart

pulls, excluding test patients that are included with the EHR for educational, illustrative, and/or demonstrative

purposes. Consultant shall register at least one (1) Active User within ninety (90) days of the Effective Date. In the

event Consultant does not meet this performance standard, Consultant's account shall be deemed a "dormant

account" and may be subject to termination at the sole discretion of Practice Fusion.

3. Marketing and Sales

3.1. Consultant's Marketing and Sales Activities. Consultant shall promote the Products to its Consultant

Practitioners by offering services including but not limited to Product installation, consulting services, and Product

maintenance. Consultant shall promote the Products to its Consultant Practitioners through an email campaign or

through another defined campaign intended to introduce Consultant's clients to Practice Fusion products that shall

take place no less than four (4) times per annum. Consultant shall provide Practice Fusion at least five (5) business

days to approve any promotional material Consultant creates, such approval not to be unreasonably withheld by

Practice Fusion. Furthermore, Practice Fusion retains the right under this Agreement and in its sole discretion to

hold quarterly meetings to ensure compliance with the intent and terms of Consultant's joint marketing and

promotional activities.

3.2. Press Release. Practice Fusion may, in its sole discretion, issue a press release announcing the business

relationship and the extent of such relationship between Practice Fusion and Consultant. Practice Fusion shall obtain

approval of any such press release from Consultant prior to its publication and/or distribution. Consultant shall

obtain approval from Practice Fusion prior to publishing any press release(s) that mention Practice Fusion and/or its

trademarks in any way. Any breach of this provision, whether material or non-material, is subject to immediate

termination of this Agreement at the discretion of the non-violating party.

3.3. Modification of Promotional Materials. Unless Consultant has received explicit, authorized approval from

Practice Fusion, Consultant shall not modify, add to, or delete statements created and/or published by Practice

Fusion.

4. Confidentiality

4.1. Confidentiality Obligations. Each party agrees to maintain in confidence the Confidential Information of the

other party. Each party shall at all times, during the term of this Agreement and for a period of five (5) years

following the termination of this Agreement, keep in confidence all such Confidential Information, and shall not use

such Confidential Information without the other party's written consent except in performance of its duties under

this Agreement. Neither party will disclose the Confidential Information to any person except its employees to

whom it is necessary to disclose the Confidential Information for purposes permitted under this Agreement. Each

party will take reasonable measures to maintain the confidentiality of the Confidential Information, but not less than

the measures it uses for its confidential information of similar type, but in no event shall such precautions constitute

less than reasonable care. Each party will immediately give notice to the other party of any unauthorized use or

disclosure of the Confidential Information. Each party agrees to assist the other party in remedying such

unauthorized use or disclosure of the Confidential Information.

4.2. Injunctive Relief. Consultant agrees that if Consultant breaches or threatens to breach Sections 3 or 4 in any

manner, Practice Fusion will suffer irreparable damage, money damages may be inadequate, and Practice Fusion

shall be entitled to preliminary injunctive relief and other injunctive relief by a court of competent jurisdiction,

without posting a bond and without Practice Fusion having to wait five (5) days for Consultant to cure its breach. Page 3 of 5

042_11232011_PF-CCN.11_2011

Said injunctive relief shall be in addition to, and in no way in limitation of, any and all other remedies Practice

Fusion may have in law or equity for the enforcement of this Agreement.

5. Disclaimer of Warranty and Limitation of Liability

5.1. DISCLAIMER OF WARRANTIES. PRACTICE FUSION MAKES NO WARRANTY, EXPRESS OR

IMPLIED, AND SPECIFICALLY DISCLAIMS THE IMPLIED WARRANTIES OF MERCHANTABILITY AND

FITNESS FOR A PARTICULAR PURPOSE, AS TO ANY MATTER WHATSOEVER, INCLUDING BUT NOT

LIMITED TO THE PRODUCTS, SERVICES AND ANY HARDWARE, SOFTWARE OR APPLICATIONS

PROVIDED BY PRACTICE FUSION TO CONSULTANT CLIENT, DOCUMENTATION, DATA FILES,

OUPUT, OR OTHER MATTERS PRODUCED OR PROVIDED HEREUNDER. PRACTICE FUSION MAKES

NO WARRANTY THAT THE SERVICES PROVIDED HEREUNDER WILL MEET CONSULTANT'S

CLIENT'S REQUIREMENTS, THAT THE OPERATION OF THE SERVICES WILL BE UNINTERRUPTED

OR ERROR FREE, OR THAT ALL DEFECTS WILL BE CORRECTED. PRACTICE FUSION WILL NOT BE

RESPONSIBLE FOR ANY DAMAGES THAT CONSULTANT'S CLIENTS MAY SUFFER ARISING OUT OF

USE, OR INABILITY TO USE, THE PRODUCTS OR SERVICES. PRACTICE FUSION WILL NOT BE

LIABLE FOR UNAUTHORIZED ACCESS TO OR ALTERATION, THEFT OR DESTRUCTION OF

CONSULTANT'S CLIENT'S DATA FILES, PROGRAMS, PROCEDURES OR INFORMATION THROUGH

ACCIDENT, FRAUDULENT MEANS OR DEVICES, OR ANY OTHER METHOD, UNLESS SUCH ACCESS,

ALTERATION, THEFT OR DESTRUCTION IS CAUSED AS A RESULT OF PRACTICE FUSION'S

MISCONDUCT.

5.2. EXCLUDED LIABILITIES. IN NO EVENT WILL PRACTICE FUSION'S LIABILITY UNDER THIS

AGREEMENT OR IN CONNECTION WITH THE PRODUCTS AND SERVICES PROVIDED BY PRACTICE

FUSION, REGARDLESS OF THE FORM OF ACTION, INCLUDING ANY INDIRECT, INCIDENTAL,

SPECIAL, OR CONSEQUENTIAL DAMAGES OR CLAIMS FOR LOSS OF BUSINESS OR PROFITS, UNDER

CONTRACT, TORT (INCLUDING NEGLIGENCE), OR OTHER LEGAL THEORY, REGARDLESS OF THE

CAUSE OF ACTION AND EVEN IF PRACTICE FUSION HAS BEEN ADVISED OF THE POSSIBILITY OF

SUCH POTENTIAL LOSS OR DAMAGE.

6. Indemnification

6.1. Practice Fusion's Indemnity Obligations. Practice Fusion agrees to indemnify, defend, and hold harmless

Consultant from and against any losses, liability, claims, damages, penalties, costs, fees or expenses arising from or

in connection with any action, proceeding or claim made or brought against Consultant by any third party cause by

or arising directly or indirectly from any act or omission of Practice Fusion relating to the Product including any

allegations the Product infringes any United States patents, copyrights, trade secrets or other proprietary rights of

any third party.

6.2. Limitation(s) on Practice Fusion Indemnity. Practice Fusion shall have no obligation under this Section 6 for

any claims, actions or demands that result from (i) use of the Products in a combination or manner that violates the

rights of third parties or in a combination with materials or products not supplied by Practice Fusion; or (ii) the

modification of the Products by parties other than Practice Fusion.

6.3. Consultant's Indemnity Obligations. Consultant agrees to indemnify, defend, and hold harmless Practice Fusion

from and against any losses liability, claims, damages, penalties, costs, fees or expenses arising from or in

connection with any action, proceeding or claim made or brought against Practice Fusion by any third party caused

by or arising directly or indirectly from any breach by Consultant of this Agreement or any act or omission of

Consultant pursuant to the exercise of its rights under this Agreement, including without limitation from any use,

demonstration or marketing of the Products.

6.4. Limitation(s) on Consultant Indemnity. Consultant's obligations under Section 6.3 above are contingent upon (i)

Practice Fusion giving prompt written notice to Consultant of any such claim, action or demand, (ii) Practice Fusion

allowing Consultant to control the defense and any related settlement, and (iii) Practice Fusion fully assisting in the

defense so long as Consultant pays Practice Fusion's out-of-pocket expenses and/or fees.Page 4 of 5

042_11232011_PF-CCN.11_2011

7. Covenants

7.1. Compliance with Laws. Consultant shall comply with all applicable laws with respect to the Products and

Consultant's performance of the terms of this Agreement. Consultant will not undertake any deceptive, misleading,

or unethical business practices. Consultant is strictly prohibited from disparaging or impugning the integrity of

Practice Fusion or any of its products or services, any of its employees, officers, directors, authorized

representatives, accountants, attorneys, and/or investors, regardless of the type of statement, and regardless of the

forum through which such statements may be made. This provision shall survive the termination of this Agreement.

7.2. Illegal Activities. Consultant represents and warrants that all promotional means Consultant engages in: (i) will

not be unethical or illegal under applicable laws, including but not limited to the CAN SPAM Act of 2003 (Public

Law 108-187) or any amendment/succession to any applicable legislation; or (ii) contain any illegal or fraudulent

content.

7.3. No Representations and Warranties to Customers. Consultant will not, and acknowledges that it is not

authorized to, make any representations or warranties regarding the Products to clients or potential clients on behalf

of Practice Fusion.

7.4. Accurate Information. Consultant agrees to provide Practice Fusion with accurate information about Consultant,

each Consultant Practitioner's Contact Information, including but not limited to all business names, addresses,

phone numbers, email addresses, and any other information that may be requested by Practice Fusion from time to

time, upon registration of each such Consultant Practitioner, and Consultant's promotional methods at Practice

Fusion's request.

8. Term and Termination

8.1. Term. This Agreement shall have an initial term of one (1) year commencing on the Effective Date, and shall

automatically renew each year for additional and successive one (1) year terms, until terminated in accordance with

this section. Either party may terminate this Agreement with or without cause, at any time, provided that written

notice is given to the non-terminating party. Termination shall be effective upon receipt of such notice.

8.2. Effect of Termination. Upon termination, all Confidential Information and sales or promotional materials shall

remain the property of Practice Fusion and Consultant shall return such items to Practice Fusion or certify their

destruction within thirty (30) days of the date of termination. Consultant shall also cease use of any of Practice

Fusion's trademarks, and all related products and services associated with Practice Fusion. The provisions of this

Agreement that, by their nature, require performance following the termination or expiration of this Agreement shall

survive the termination or expiration of this Agreement.

9. General Terms

9.1. No Profit Sharing. The parties to this Agreement hereby agree that any profit(s) or benefit(s) earned by either

party, whether monetary and/or of monetary value, will not be allocated, distributed, or shared with the other party

in any way.

9.2. Independent Relationship. The parties to this Agreement are independent contractors. There is no relationship of

agency, partnership, joint venture, employment, or franchise between the parties in any way.

9.3. Assignment. Consultant may not transfer or assign any rights or delegate any duties under this Agreement

without the prior written consent Practice Fusion. Practice Fusion shall be permitted to transfer or assign this

Agreement in connection with a merger, sale, or acquisition of all or substantially all of its assets.

9.4. Governing Law; Jurisdiction; Venue. This Agreement will be governed by and construed in accordance with the

laws of the State of California, excluding its conflict of laws principles. The parties hereby expressly consent to (i)

personal jurisdiction of and venue in the state or federal courts located in and serving San Francisco County,

California, and (ii) to service of process being effected upon them by registered mail sent to the addresses set forth Page 5 of 5

042_11232011_PF-CCN.11_2011

in the beginning of this Agreement. Each party waives a jury trial in any matter arising out of or relating to this

Agreement.

9.5. Notices. All notices, reports, requests, approvals and other communications required or permitted under this

Agreement must be in writing and shall be sent to the receiving party's initial address set forth in the first paragraph

of this Agreement or to such other address that the receiving party may have provided for purpose of notice by

notice as provided in this section.

9.6. Force Majeure. The obligations of the parties under this Agreement shall be suspended to the extent a party is

hindered or prevented from complying therewith because of labor disturbances (including strikes or lockouts), war,

terrorist attack, acts of God, earthquakes, fires, storms, accidents, governmental regulations, failure of vendors or

suppliers or any other cause whatsoever beyond a party's control. For so long as such circumstances prevail, the

party whose performance is delayed or hindered shall continue to use all commercially reasonable efforts to

recommence performance without delay.

9.7. No Bias. This Agreement shall be interpreted as written and negotiated jointly by the parties.

9.8. Severability. If any part of this Agreement is found invalid or unenforceable, that part will be amended to

achieve as nearly as possible the same economic effect as the original provision and the remainder of this

Agreement will remain in full force.

9.9. Entire Agreement. This Agreement, and the agreements incorporated by reference herein, constitutes the entire

agreement between the parties relating to this subject matter and supersedes all prior or simultaneous

representations, discussions, negotiations, and agreements, whether written or oral. This Agreement may be

amended or modified only by a writing that is signed by duly authorized representatives of both parties. No term or

provision of this Agreement will be considered waived by either party, and no breach excused by either party, unless

such waiver or consent is in writing signed by a duly authorized representative on behalf of the party against whom

the waiver is asserted.



TO AGREE TO THESE TERMS, CLICK "AGREE." IF YOU DO NOT AGREE TO THESE TERMS, DO NOT CLICK "AGREE" AND DO NOT USE THE PRODUCTS PURSUANT TO THE CERTIFIED CONSULTANT NETWORK PROGRAM.

EXHIBIT A

[Intentionally Left Blank]

EXHIBIT B

Certified Consultant Network (CCN) Program Specifications
Practice Fusion offers the following titles and promotional services pursuant to Section 3.2 of this Agreement.
Title Qualification Services
"Certified Consultant" Completed Practice Fusion Training; less than 20 SUPER user* sign-ups Training materials
Listing on Practice Fusion's CCN website
"Preferred Consultant" 20 SUPER user* sign-ups All "Certified Consultant" services (above)
Preferred listing on Practice Fusion's CCN website
Referrals
"Premier Consultant" 50+ SUPER user* sign-ups All "Preferred Consultant" services (above)
Press release by Practice Fusion announcing partnership
Banner advertisement within Practice Fusion's EHR application promoting the Consultant's services


*For purposes of this Agreement only, "SUPER user" shall be defined as a registered user of Practice Fusion's electronic health records application ("EHR") that records at least one-hundred (100) chart-pulls, excluding test patients that are included with the EHR for educational, illustrative, and/or demonstrative purposes.

PROVIDER AGREEMENT


Page 1 of 3 Initials __________

CONSULTING AGREEMENT
This Consulting Agreement (the "Agreement") is made as of the last date on which it is signed by one of the parties as indicated on the signature page hereof by and between ____________________________________ ("Consultant"), an independent consultant in Practice Fusion's Certified Consultant Network, and having its principal place of business at __________________________________, and _____________________________________ ("Provider"), having an address at ___________________________________.
Overview About Consultant: Consultant is an independent contractor and is not an employee, agent, or partner of Practice Fusion in any way. Consultant hereby attests that it is a certified consultant in good standing within Practice Fusion's Certified Consultant Network. Consultant further acknowledges that he/she meets the minimum competency requirements to carry out the tasks necessary to enroll and provide assistance to you, the Provider. For reference and illustrative purposes only, Practice Fusion provides a free, web-based Electronic Health Record (EHR) system to physicians across the US. With charting, scheduling, e-prescribing, billing, lab integrations, referral letters, unlimited support and a Personal Health Record for patients, Practice Fusion's EHR addresses the complex needs of today's healthcare providers and disrupts the health IT status quo. Practice Fusion is the fastest growing EHR community in the country with more than 70,000 users and 8 million patients.

Scope of Work and Responsibilities of Consultant
Consultant acknowledges that, with respect to the implementation process, the performance obligations of Consultant are, subject to the terms and conditions set forth in this Agreement and Exhibit A attached hereto: (i) To successfully enroll Provider in Practice Fusion's EHR, included all of the features in the EHR to the fullest extent possible.
(ii) To actively demonstrate the features of Practice Fusion's EHR pursuant to terms in Exhibit A in a professional, competent, and timely manner.

Consultant Contact Information
Company: ______________________________
Mailing Address: ________________________
_______________________________________
Email/Phone/Fax: ________________________


Cost and Payment Terms Consultant agrees to train Provider and other office and staff members for ___________ hours / days (circle one). The fee for Consultant's service(s) shall not exceed $125 (One hundred and twenty five dollars) per hour. Any changes to the fees will require the prior written approval of the Provider. Invoicing will occur every fourteen (14) days, and payment will be due fourteen (14) days from the invoice date, unless Consultant and Provider mutually agree to separate terms.

Term and Termination This Agreement is made as of the last date on which it is signed by one of the parties as indicated on the signature page hereof and will terminate on a mutually acceptable date.
Either party may terminate this Agreement with fourteen (14) days written notice, with all outstanding performance and financial obligations surviving the termination.

Page 2 of 3 Initials __________

Representation and Warranties Warranty – Consultant warrants that his/her performance obligations hereunder will be performed in a professional and workmanlike manner conforming to generally accepted industry standards and practices, and in accordance with all applicable law, regulations, codes and standards of government agencies or authorities having jurisdiction. EXCEPT AS OTHERWISE EXPRESSLY SET FORTH IN THIS SECTION OR AN APPLICABLE EXHIBIT, CONSULTANT MAKES NO WARRANTY AS TO THE RESULTS THAT MAY OR MAY NOT BE OBTAINED BY PROVIDER IN CONNECTION WITH THE SERVICES. CONSULTANT DISCLAIMS ANY AND ALL WARRANTIES, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT.
Limitation of Liability – NEITHER PARTY SHALL BE LIABLE TO THE OTHER PARTY FOR ANY INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES ARISING IN CONNECTION WITH THIS AGREEMENT, INCLUDING, WITHOUT LIMITATION, LOST PROFITS OR LOSS OR DAMAGE TO DATA ARISING OUT OF THE USE, PARTIAL USE OR INABILITY TO USE THE RESULTS OF THE PERFORMANCE OBLIGATIONS, WHETHER IN AN ACTION IN CONTRACT, TORT, STRICT LIABILITY OR NEGLIGENCE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE.

Indemnification The Parties agree to indemnify, defend, and hold harmless Practice Fusion from and against any losses liability, claims, damages, penalties, costs, fees or expenses arising from or in connection with any action, proceeding or claim made or brought against Practice Fusion by any third party caused by or arising directly or indirectly from any breach by either Party of this Agreement or any act or omission of either Party pursuant to the exercise of its rights under this Agreement.

Compliance The Parties shall comply with all applicable laws with respect to the performance obligations stated in this Agreement. The Parties further agree not to undertake any deceptive, misleading, or unethical business practices, nor make nay false or misleading representations or disparaging remarks about the other Party.

Independent Relationship The Parties to this Agreement, as well as Practice Fusion, are all independent contractors. There is no relationship of agency, partnership, joint venture, employment, or franchise between the parties in any way.

Severability If any part of this Agreement is found invalid or unenforceable, that part will be amended to achieve as nearly as possible the same economic effect as the original provision and the remainder of this Agreement will remain in full force.

Entire Agreement This Agreement, including all Exhibits hereto, and the agreements referenced herein, constitutes the entire agreement between the parties relating to this subject matter and supersedes all prior or simultaneous representations, discussions, negotiations, and agreements, whether written or oral. This Agreement may be amended or modified only by a writing that is signed by duly authorized representatives of both parties. IN WITNESS WHEREOF, the parties have respectfully caused this Agreement to be executed by their duly authorized representative as of the Effective Date set forth above or hereinafter indicated.

CONSULTANT PROVIDER
Sign: _____________________________ Sign: _____________________________
Print: _____________________________ Print: _____________________________
Date: _____________________________ Date: _____________________________

Page 3 of 3 Initials __________


EXHIBIT A
Implementation Checklist
The following items detail the scope of work that will be performed by the Consultant for the Provider:
Step 1: Enroll the Provider's office for the Practice Fusion application
  • Create a new EHR account for the medical practice using your tracking link:
    • Example: www.practicefusion.com/ccn/Your-IT-Company-Goes-Here
Step 2: Check that the Provider's hardware is adequate to support the Practice Fusion application
  • Test the practice internet connection
  • Review minimum hardware requirements
    • Intel ® Celeron ®' 2GHz or faster processor or equivalent, 1024x768 minimum screen resolution and 1GB of
  • RAM
  • For more detailed requirements go to our System Requirements Page
  • Does the computer have Adobe Flash?
    • Log in using their credentials
Step 3: Customize the Provider's account
  • Give your Provider the Practice Fusion Quickstart Guide (a roadmap to getting started)
  • Identify and add users in the Practice Fusion application (MDs, nurses and office staff)
  • Import patients from Provider's billing or third party system
    • Import into an Excel or CSV file or schedule a patient import by emailing support@practicefusion.com
  • Set up e-prescribing
    • Gather the physician's name, license, practice ID, username, NPI and DEA number to fill out the Eprescribing Verification Request form and fax it to Practice Fusion at 1-888-953-2009
  • Activate labs
    • Select the lab partners the Provider uses and enter their account number and Lab Rep's information. Let the Provider know they will be contacted when integration is activated.
  • Create templates
  • Set up billing
    • Superbills can be created from a Chart Note in Practice Fusion and you can either provide your own billing services to your client, help them continue with their existing billing or transition them to our integrated billing partner, Kareo.
  • Scan or upload any important documents directly into the EHR
  • Identify referral recipients and add referral network
  • Create forum screen names for your clients
*For additional training on how to set up an account, please go to http://learn.practicefusion.com Step 4: Train the Provider on all of the following features
  • Charting
  • Scheduling
  • Billing
  • Messages and documents
  • E-Prescribing
  • Labs
  • Customizing templates/accounts