Confidentiality and Security Agreement - South Atlantic IT&S ... 2026

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  1. Click ‘Get Form’ to open the Confidentiality and Security Agreement in the editor.
  2. Begin by filling out the 'Access Requested' section. Indicate whether you are requesting new access or modifying existing access, and specify your primary facility.
  3. Complete the 'Practice Information' section with your practice/company name, specialty, address, and contact details for both the IT&S contact and Office Manager.
  4. In the 'Personal Information' section, provide your full name, home address, date of birth, email address for authentication purposes, personal cell number, and role.
  5. Ensure you sign the Confidentiality and Security Agreement on page 3. This signature confirms your understanding and agreement to comply with all terms outlined in the document.
  6. Once completed, return the form via fax or email as specified. If submitting for multiple users, ensure all forms are sent together.

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