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]		Limitations (Contractual / Business Practices)[7]		Limitations (Technical / Practical)[8]
					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:		Limitations of a contractual nature (including developer policies and other business practices) that a user may encounter:		Limitations of a technical, technological or practical nature that a user may encounter that could:
					> the capability.	> any data generated in the course of using the capability.	> in the implementation or use of the capability.	> in connection with the data generated in the course of using the capability.	> prevent or impair the successful implementation, configuration, customization, maintenance, support, or use of the capability.	> prevent or limit the use, exchange, or portability of 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, subject to the limitations noted. 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 limitations and additional types of costs that may apply for these and other third-party HISPs.	Braintree Ambulatory Version 9.3.1.1		Account for each provider will be charged	None	None	None	None	The user will not be able to exchange emails with those parties whose certificates are not discoverable. In order to send the secured emails to other customers there public certificates should be discoverable	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 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	Need to have internet connection and needs to work with facility IT for network security settings	None
Syndromic Survelliance [Relevant certification criteria: §§ 170.314(f)(2) ]	This functionality allows users to send syndromic survellance s to other providers. Our syndromic survellance support is  related to Meaningful Use and ONC requirements for isyndromic survellance.	Braintree Ambulatory Version 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	Need to have internet connection and needs to work with facility IT for network security settings	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 syndromic survellance s to other providers. Our syndromic survellance support is  related to Meaningful Use and ONC requirements for isyndromic survellance.	Braintree Ambulatory Version 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	Need to have internet connection and needs to work with facility IT for network security settings	None
ambulatory setting only - cancer registries [Relevant certification criteria: §§ 170.314(f)(4) ]	This functionality allows users to transmission of  cancer case information. Our  support is  related to Meaningful Use and ONC requirements for  cancer case information	Braintree Ambulatory Version 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	Need to have internet connection and needs to work with facility IT for network security settings	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 cancer registries. Our  support is  related to Meaningful Use and ONC requirements for  transmission to cancer registries.	Braintree Ambulatory Version 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	None	None
ambulatory setting only – transmission to public health agencies – syndromic surveillance [Relevant certification criteria: §§ 170.314(f)(7) ]	This functionality allows users to  transmission to public health agencies – syndromic surveillance. Our  support is  related to Meaningful Use and ONC requirements for transmission to public health agencies – syndromic surveillance.	Braintree Ambulatory Version 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	Need to have internet connection and needs to work with facility IT for network security settings	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 9.3.1.1		Account for each provider will be charged	None	None	None	None	The patient data for synchronization will be done every 10 minutes	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 9.3.1.1		Annual licensing and subscription fee included in base service agreement.	None	None	None	None	The report data generation will complete on the next day of the job submitted	None

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[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.

[7]

Developers should describe with particularity the nature, magnitude, and extent of the limitations. This description should, if relevant, include an explanation of how the limitations associated with non-certified capabilities may interfere with the use or implementation of any certified capability.

[8]

Developers should describe with particularity the nature, magnitude, and extent of the limitations. This description should, if relevant, include an explanation of how the limitations associated with non-certified capabilities may interfere with the use or implementation of any certified capability.