STEP 1: HIPAA Authorization for the Disclosure of Health Information
By signing below, I acknowledge that I have read and understand this Authorization and that I agree to its terms. Further, I authorize the disclosure of the information set forth herein in accordance with the terms of this Authorization.
Each attendee must create their own registration to receive an email stating the submission has been verified.
All pictures of self-administered tests must have your first and last name, and date of test to be verified.
If you are submitting a COVID-19 test result record from a clinic, the record submitted must include your first and last name, date of test, type of test, and the clinic name.
By signing below, I hereby acknowledge and agree that I have read the Agreement and agree to all terms and conditions contained therein.
If you encounter any problems during the submissions process, please contact firstname.lastname@example.org and enter your event name in the subject line.