Business Associate Agreement Page 3

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10. Survival. The obligations imposed by this Agreement shall survive any expiration or
termination of this Agreement.
Insert Clinic Name
VENDOR: _________________________
Sign: _____________________________
Sign: ______________________________
Name: ____________________________
Name: _____________________________
Title: _____________________________
Title: ______________________________
Date: _____________________________
Date: ______________________________
Return to: Insert Clinic Name , Address
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