There is a one-time setup cost for activation and training and an ongoing monthly fee to access this certified product. This certified product-version may require ongoing monthly costs to support online patient service (170.314.e.1). Patient portal service allows patients to view their health information online as well as download and transmit a summary of their healthcare information to a third party electronically. The ongoing monthly cost is a flat rate per provider facility. This certified product-version may require one-time and monthly costs to establish interfaces for reporting to immunization registries, cancer registries, and sending data to public health agencies (170.314.f.2, 170.314.f.4, 170.314.f.6). The one-time cost is charged at the facility level per interface. The monthly costs are based on the volume of messages sent to the registry in blocks of 1000 messages. This certified product-version may require one-time and montly costs to to support sending and receiving electronic suammary of care records with other ONC certified systems that are outside the product�s HISP network, 170.314(b)(1). This certified product-version may also require fees per transaction to support 170.314(b)(1). This certified product-version may require an annual fee to allow multiple mass data export to support (170.314.b.7) and limit that functionality to only once every 24 hours to ensure optimal system performance. This certified product-version may require an ongoing annual fee to support PQRS/CQM submission (170.314.c.1, 170.314.c.2, 170.314.c.3). This certified product-version requires an annual agreement with a 6 month termination clause.