Common Contracts
6 similar Registration Agreement contracts
ContractRegistration Agreement • May 23rd, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
ContractRegistration Agreement • May 23rd, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
ContractRegistration Agreement • May 23rd, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
ContractRegistration Agreement • March 10th, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
ContractRegistration Agreement • March 10th, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
ContractRegistration Agreement • March 8th, 2022
REGISTRATION AGREEMENT About this Agreement: The Arizona Department of Health Services (ADHS) has designated Health Current to operate the Arizona Healthcare Directives Registry (“AzHDR”). The AzHDR is a free registry that provides secure electronic storage and access to advance directives. This registry service is NOT the Health Current health information exchange (HIE). PLEASE READ THIS DOCUMENT CAREFULLY. Thisis a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement:• Read the agreement and complete this form.• Fill in all blank spaces on this form.• Sign and date form.• Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR.• Mail to: AzHDR – Health Current3877 N. 7th St., Ste. 150Phoenix, AZ 85014• Or fax to: 602
