Review and e-sign to submit your registration. You are designated Site Administrator for your practice (you can delegate later).
1 · Purpose
This agreement governs access to the Comprehensive Integrated Care (“CIC”) Physician Referral Portal by the practice identified above (“Referring Practice”) for the sole purpose of referring patients to CIC and receiving treatment results for patients with whom the Referring Practice has a treatment relationship.
2 · Permitted use
Portal access is limited to workforce members authorized by the practice’s Site Administrator. Users may access only records of patients referred by the Referring Practice. Credentials are individual and must not be shared.
3 · Privacy & security
Each party shall comply with HIPAA and applicable Arizona law (including A.R.S. §36-664 and §12-2802). The Referring Practice will notify CIC within one business day of any suspected unauthorized access and will terminate departing workforce members’ access the same day (§4.2).
4 · Administration
4.1 — CIC may suspend access for non-response to the semi-annual user revalidation. 4.2 — Termination notices are actioned by CIC the same business day. CIC audits all record access; audit trails are retained for at least six years.
Exhibit A — Site Administrator
The registrant below is designated Site Administrator and may invite and deactivate practice staff accounts within the portal.