HIPAA AUTHORIZATION TO DISCLOSE HEALTH INFORMATION

I hereby authorize health care professionals, hospitals, clinics, laboratories, and all other medical or medically-related providers, facilities, or services (collectively referred to as "health care providers") to disclose my protected health information to GreenSky, LLC, GreenSky Patient Solutions, LLC, and any and all corporate affiliates (collectively, "GreenSky") and the financial institution identified on my loan agreement ("Lender") for the purpose of facilitating and servicing the Loan, and determining the accuracy and validity of charges financed with the Loan. I also hereby authorize GreenSky to communicate with health care providers to discuss the services that I seek to finance with the Loan.

The protected health information I authorize to be disclosed includes all health information related to the services financed under the Loan, including, but not limited to, administrative and billing records and dates of service. This authorization does not authorize disclosure of protected health information concerning HIV/AIDS, treatment for drug or alcohol abuse and mental health, which shall require separate authorization.

I understand that signing this authorization is voluntary, but that signing this authorization is a condition for receiving this Loan. Refusal to sign this authorization will end my consideration for this Loan.

I also understand that information disclosed to GreenSky and/or Lender may no longer be protected by the privacy protections established by HIPAA and may be re-disclosed by GreenSky and/or Lender. However, the health information obtained pursuant to this authorization may only be used or disclosed for the purposes of facilitating and servicing the Loan, and determining the accuracy and validity of charges financed with the Loan.

This authorization will expire upon repayment of the Loan, or the cancellation or closure of the Loan by GreenSky and/or Lender. To the extent applicable state law requires expiration of an authorization in a shorter period of time, this authorization will expire consistent with that requirement.

I understand that I have the right to:

1. Revoke this authorization at any time by sending written notice to GreenSky. I am aware that such revocation will not affect information that has already been disclosed pursuant to this authorization
2. Receive a copy of this authorization.

Version Effective July 15, 2017 v.2