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SETON HEALTHCARE FAMILY COMPASS ACCESS AGREEMENT THIS FORM WILL NOT BE PROCESSED IF IT IS NOT PROPERLY COMPLETELY AND SIGNED BY EACH USER AS INDICATED ON THE COMPASS ACCESS INSTRUCTION SHEET. Office / Clinic Name:
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Document Date: 2013-10-04 12:58:35

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File Size: 239,10 KB

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Company

Dell / Seton Information Systems / /

Facility

University Medical Center / Clinic Email / Brackenridge Dell Children’s Medical Center of Central Texas Seton Medical Center Austin Seton Northwest Seton Southwest Healthcare Center SSW / Clinic Name / Clinic Address / /

IndustryTerm

healthcare operations / /

Organization

Brackenridge Dell Children’s Medical Center of Central Texas Seton Medical Center Austin Seton Northwest Seton Southwest Healthcare Center SSW / University Medical Center / Healthcare Family Medical Staff Office / /

Person

Jane A Doe / /

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Position

physician / Clinic Manager / supervising physician / office/clinic manager / /

Region

Central Texas / /

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