ACCEPTANCE OF ARIZONA PRIORITY CARE’S EZ-NET DATA ACCESS TERMS Sample Clauses

ACCEPTANCE OF ARIZONA PRIORITY CARE’S EZ-NET DATA ACCESS TERMS. CONDITIONS I understand and accept that being granted access to Arizona Priority Care’s on-line application, named EZ-Net involves my assuming considerable responsibility for maintaining the integrity and security of Arizona Priority Care’s data. I am responsible for the privacy and confidentiality of any Arizona Priority Care’s data to which I have access. My signature affixed certifies that I have read and agree to the terms and conditions stated in the first paragraph and will comply with all requirements as directed by Arizona Priority Care. Requestor Signature (Required): Manager/Physician of Group Signature (Required): Date: NOTICE: This communication is intended for the use of the individual or entity to whom it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this communication is not the intended recipient, or the employee or the agent responsible for delivering the communication to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone, email or facsimile and disregard this form Provider Relations Rep Name: Internal Use Only:  Approved:  Denied:  Tracker: