Your Name (required)
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HIPAA Confidentiality Agreement (required)
Pacific Vascular Inc. (PVI) is pleased to offer your office access to our Physician Web Portal. You will have internet access to your patients’ vascular ultrasound reports and images with your assigned user name and password.
When using this Web access, federal and state laws require that PVI take appropriate steps to protect against the unauthorized use and disclosure of patient’s electronic record. The Health Insurance Portability and Accountability Act (“HIPAA”) allows health information concerning individual patients to be disclosed to another health care provider for purposes relating to medical treatment of the patient.
To assure this protection of patients’ protected health information from unauthorized use or disclosure, PVI requests you agree to the following conditions:
PVI reserves the right to terminate this agreement and your participation with our web portal upon making a determination on their sole discretion that there has been a violation or breach of any of the terms and conditions of this agreement.
I acknowledge that I have read and understand the terms and conditions of the Confidentiality Agreement set forth by Pacific Vascular Inc. by signing and dating below.
Acknowledgement of terms & conditions of the HIPAA Confidentiality Agreement
Additional Message or Question
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