By filling out the below, I certify that I am an employee, officer, consultant, agent, or independent contractor of a current Customer of Healthcare Systems and Technologies, LLC (“HST”), which Customer is a party to an active licensing or support services agreement with HST. I further certify that I am authorized by Customer to access this portal and will do so for the sole purpose of conducting Customer’s internal business operations. I agree that I will not use the information in this portal for purposes outside the scope of Customer’s existing agreement with HST and I will not disclose the proprietary information of HST to any third party except as expressly permitted under Customer’s agreement with HST.

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