I attest that the information I have provided to complete the PQRS MOC incentive is true and accurate to the best of my knowledge and ability. I understand that my specialty certifying board, in its review of my compliance with these requirements for this incentive may audit the activities submitted and I give my consent and agreement to participate in any such audit. I understand that I must maintain the patient charts for which data has been submitted, and that these charts must be accessible in the event of an audit. If audited, I agree to provide the charts to my specialty certifying board and to do so in a manner consistent with HIPAA requirements and regulations. Furthermore, I agree that data resulting from the PQRS MOC Incentive activitiy may be used in an anonymous/unidentifiable manner, for research and statistical purposes. I understand that providing false or misleading information on this attestation or not cooperating with an audit may result in disciplinary action by the AOA, up to and including revocation of my AOA Board Certification and suspension or revocation of my membership status. I give my permission to allow the AOA to release this information to CMS.