Template for Mandatory Disclosures[1]          
Capability[2] Description of capability[3] Product A[4] Product B Types of Costs or Fees to be paid by a provider for the capability[5] Additional Types of Costs or Fees[6]
Additional types of costs or fees that a user may be required to pay to purchase, license, implement, maintain, upgrade, use, or otherwise enable and support the use of:
> the capability. > any data generated in the course of using the capability.
Direct messaging functionality (including transitions of care, discharge summaries, and clinical messaging functionality).

[Relevant certification criteria: �� 170.314(b)(1) and (2), h(1).]		 This functionality allows users to send and receive Direct-based messages to/from other users of certified health IT systems. Direct messages may include clinical data, notes, and other information.

Our Direct offerings support related Meaningful Use and ONC requirements for sending and receiving transitions of care summary documents. We also support a range of other messaging options.

Our Direct capabilities include bundled Health Internet Service Provider (HISP) services for facilitating message exchange. However, see additional types of costs that may apply for these and other third-party HISPs.
Braintree Ambulatory Version 10.5.1.1 Account for each provider will be charged None None
Immunization registries
[Relevant certification criteria: �� 170.314(f)(1) ]		 This functionality allows users to send immunziation registries to other providers..

Our Immunization registries support is related to Meaningful Use and ONC requirements for immunization registries.
 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
Syndromic Survelliance
[Relevant certification criteria: �� 170.314(f)(2) ]		 This functionality allows users to send syndromic survellance� to other providers.

Our syndromic survellance support is� related to Meaningful Use and ONC requirements for syndromic survellance.
 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
Transmission to public health agencies � reportable laboratory tests and value/results
[Relevant certification criteria: �� 170.314(f)(3) ]		 This functionality allows users to send lab values/results to other providers.

Our reportable laboratory tests and value/results support is� related to Meaningful Use and ONC requirements for lab values/results.
 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
ambulatory setting only -Transmission to public health agencies � electronic case reporting
[Relevant certification criteria: �� 170.314(f)(5) ]		 This functionality allows users to transmission to electronic case reporting to public health agencies

Our� support is� related to Meaningful Use and ONC requirements for� transmission to electronic case reporting		 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
ambulatory setting only � transmission to public health agencies � health care surveys
[Relevant certification criteria: �� 170.314(f)(7) ]		 This functionality allows users to� transmission to public health agencies � health care surveys

Our� support is� related to Meaningful Use and ONC requirements for transmission to public health agencies � health care surveys.
 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
electronic prescribing
[Relevant certification criteria: �� 170.314(b)(3) ]		 This functionality allows users to� send signed eprescriptions of the patients.

Our� support is� related to Meaningful Use and ONC requirements for electronic prescriptions		 Braintree Ambulatory Version 10.5.1.1 Account for each provider will be charged None None
Clinical quality measures
[Relevant certification criteria: �� 170.314(c)(1) -170.314(c)(4)]		 This functionality allows users to� generate clinical quality reports.

Our� support is� related to Meaningful Use and ONC requirements for clinical quality measures		 Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.�� None None
Encrypt authentication credentials The functionality allows the system to encrypt authentication details of the user credentials. Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement.� None None
[Relevant Certification Criteria
170.315(d)(12) Encrypt authentication credentials]
Multi-factor authentication We support google authentication two way factor authentication. The system can enable the authentication factor on user level. If google authentication is enabled the system will ask to enter the google authentication good and if verification code matches system allows the user to login to the application Braintree Ambulatory Version 10.5.1.1 Annual licensing and subscription fee included in base service agreement. None None
[Relevant Certification Criteria
170.315(d)(13) Multi-factor authentication]
Note: There is no additional cost for any other criteria
170.315(b)(10) Electronic Health Information Export (Cures) This functionality allows the user to export EHI for the patients Braintree Ambulatory Version 10.5.1.1 Annual Licensing and subscription fee included in base service agreement None None
[1]
ONC-ACBs and developers are not required to use this template nor to disclose any information except as required by law. These materials do not alter developers' disclosure obligations under 45 CFR 170.523(k)(1). ONC-ACBs are responsible for ensuring that developers conform to the disclosure requirements at �170.523(k)(1), as described in the preamble to the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications final rule. See 80 FR 62719 et seq.
[2]
Developers should identify the capabilities as they are marketed to prospective customers. If certified capabilities are marketed with non-certified capabilities, developers should refer to the entire bundle of capabilities using the same language that they use in their marketing materials. In addition, each capability should reference the certification criteria that the capability supports.
[3]
Developers should describe, in plain language, the intended and other reasonable uses of the capability as marketed.
[4]
Developers can use these columns to identify the products in respect to which the disclosures are made. This should reduce duplication when the capabilities identified are identical across multiple products. Each column should be headed with the name of the product (as marketed). Additional columns can be inserts for additional products.�
[5]
This category of information is not a required disclosure under 45 CFR 170.523(k)(1). It has been included for the convenience of developers who may wish to distinguish between base costs and additional costs.
[6]
Developers should describe with particularity the nature, magnitude, and extent of the additional types of costs. The disclosure must describe the factors that impact additional types of costs, including but not limited to geographical considerations, volume and usage, costs associated with necessary interfaces or other licenses or technology, and costs associated with exchange partner technology and characteristics, among other relevant factors.