Get Confidentiality And Security Agreement - South Atlantic It&s ...

Filling out the Confidentiality and Security Agreement is a crucial step for ensuring compliance with privacy and security protocols. This guide will walk you through each section of the form to help you complete it correctly and efficiently online.

Follow the steps to complete your agreement accurately.

1. Click the ‘Get Form’ button to access the Confidentiality and Security Agreement and open it in your online editor.
2. Begin by completing all required fields marked on the form. This includes your personal information such as name, home address, and date of birth. Ensure that all details are accurate.
3. In the 'Access Requested' section, specify where you will need access, indicating any primary or additional facilities as needed. You may check options such as 'New' or 'Modify' for your access requests.
4. In the 'Practice Information' section, enter the name of your practice or company, the specialty, and the address details including street, city, state, and zip code. You also need to fill in the business phone and fax numbers, as well as the names and contact information for the IT&S contact and office manager.
5. Complete the 'Personal Information' section by providing your role and any additional information required. Remember to provide a valid email for authentication purposes.
6. Make sure to sign the document where indicated to attest that you have viewed and agreed to the terms of the Confidentiality and Security Agreement.
7. If you are required to have a physician's approval for access, ensure that the physician's signature and date are included. They must also provide their credential, NPI, and name.
8. Review the completed form to confirm that all sections are filled out correctly before finalizing it.
9. Once you have verified that all information is correct, save the form, and follow your organization's protocols for submitting the completed document via fax or email.

Complete your Confidentiality and Security Agreement online to ensure a smooth processing of your access request.