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Business Associate Agreement

Parties:

Mentalyc Inc. Address: 2261 Market Street #4569, San Francisco, CA 94114 ("Mentalyc" herein)

Company The organization identified and entered into Mentalyc’s systems by its representative and set forth on the final page of this agreement ("Company" herein)

Recitals:

1. Definitions

2. Permitted Uses and Disclosures of PHI

2.1. Performance of the Agreement for Mentalyc Services

2.2. Management, Administration, and Legal Responsibilities

3. Responsibilities with Respect to PHI

3.1. Mentalyc’s Responsibilities

3.1.1. Limitations on Use, Disclosure, and Sale

3.1.2. Safeguards

3.1.3. Subcontractors

3.1.4. Reporting to Company

3.1.5. Unsuccessful Security Incidents

3.1.6. Disclosures to the Secretary

3.1.7. Access and Amendment

3.1.8. Accounting of Disclosures

3.1.9. Privacy and Security Rule Compliance

3.2. Company’s Responsibilities

3.2.1. No Impermissible Requests

3.2.2. Contact Information for Notices

3.2.3. Safeguards and Appropriate Use of PHI

3.2.4. Communicating Changes to Mentalyc

3.2.5. Communicating Restrictions to Mentalyc

3.2.6. Communicating Restrictions in Notices of Privacy Practices

4. Term and Termination

4.1. Term

4.2. Termination for Breach

4.2.1. Termination for Breach by Company

4.2.2. Termination for Breach by Mentalyc

5. Post-Termination Obligations

5.1. Return, Destruction, or Retention of PHI

5.2. Notice When Return or Destruction is Infeasible

6. Limitation of Liability

7. Notices

8. Miscellaneous

8.1. No Agency Relationship

8.2. No Third-Party Rights or Remedies

8.3. References

8.4. Assignment

8.5. Amendments; Waiver

8.6. Ambiguity

8.7. Merger; Conflicts

8.8. Severability

8.9. Governing Law

8.10. Electronic and Digital Signatures

9. Data Ownership

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