Get Fax Agreement Form - Bccdc / Phsa Laboratories - Bccdc

Filling out the Fax Agreement Form - BCCDC / PHSA Laboratories is essential for ensuring the secure transmission of personal information. This guide provides you with clear, step-by-step instructions to complete the form online.

Follow the steps to properly complete the Fax Agreement Form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Confirm that you grant permission for PHSA Laboratories to fax personal and confidential information to you by selecting either 'YES' or 'NO'.
3. Enter the fax number where the personal and confidential information will be sent. Ensure that this number is secure and accessible only to authorized personnel.
4. Fill in your billing number or clinic number to identify the specific account.
5. Provide the name of your facility, clinic, or department in the designated field.
6. Complete the address of the facility or clinic, making sure it is accurate.
7. Input the telephone number of the facility or clinic to ensure reliable communication.
8. Indicate whether you will inform PHSA Laboratories immediately if the fax number changes or if it is no longer secure by selecting 'YES' or 'NO'.
9. Sign and print your name as the authorized individual, which could be a physician or administrative director.
10. Enter the date of signing the agreement clearly in the respective field.
11. Once all information is completed, you can save your changes, download, print, or share the form for submission.

Complete your Fax Agreement Form online to ensure secure handling of personal information.