Referring Provider Acknowledgment

In exchange for permission to access a patient's medical records through the Referring Provider Portal, I, as the referring provider ("Referring Provider"), acknowledge and agree that I have read this Referring Provider Acknowledgment and agree to the following terms and conditions:

1. Referring Provider acknowledges that he or she is providing certain medical services (the "Services") for patients of the H. Lee Moffitt Cancer Center and Research Institute, Inc., and its wholly owned subsidiaries (collectively, "Moffitt"), including without limitation, H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc. (the "Hospital"), and as such, is solely granted access to the patient's medical records in support of the Referring Provider's and Moffitt's treatment, payment, health care operations, and clinical activities.
2. Referring Provider acknowledges and agrees that he or she will not do anything that will alter, damage or destroy any patient information owned or maintained by Moffitt.
3. While Moffitt uses reasonable means to protect the security, confidentiality and accuracy of its patients' medical records, Referring Provider acknowledges that Moffitt cannot guarantee the security, confidentiality or accuracy of such medical records. Additionally, while Moffitt uses reasonable means to timely update its patients' medical records, Referring Provider acknowledges that Moffitt cannot guarantee a specific turnaround time or that the patients' medical records are up-to-date.
4. Referring Provider acknowledges that the medical records of patients, which medical records are prepared and maintained at Moffitt facilities, are the sole and exclusive property of Moffitt, and the Referring Provider shall have access to such medical records only with respect to Referring Provider's patients. Referring Provider shall also comply with the Hospital's Medical Staff Bylaws or Medical Staff Rules and Regulations related to such medical records.
5. Referring Provider shall comply with the State of Florida and federal patient confidentiality laws. All documents and information that are made available to, exchanged with, or discovered, created, produced or generated by Referring Provider pursuant to this Referring Provider Acknowledgment or in providing the Services, including, but not limited to, patient information and records, Moffitt policies and procedures, reports, or other information, shall be deemed confidential and proprietary information and at all times remain the sole property of Moffitt ("Confidential Information"). Referring Provider shall take all necessary precautions to maintain the confidentiality of any such Confidential Information, shall use such Confidential Information only to the extent required to perform its Services and shall not disclose such Confidential Information to anyone other than those individuals necessary for the performance of the Services. In case of a breach by Referring Provider related to the Confidential Information, Moffitt shall have the right to seek injunctive relief in addition to any and all other rights and remedies that Moffitt may have.
6. Referring Provider acknowledges and agrees that Moffitt may discontinue the Referring Provider Portal at any time.
7. Referring Provider acknowledges and agrees that the terms and conditions in this Referring Provider Acknowledgment shall be construed and interpreted in accordance with, and shall be governed by, the laws of the State of Florida and applicable Federal law. Any suit, action or proceeding with respect to or arising out of this Referring Provider Acknowledgment shall have as its venue Hillsborough County, Florida. In any action or dispute that may arise out of or otherwise relate to this Referring Provider Acknowledgment, the prevailing party shall recover its legal expenses, including reasonable attorneys' fees, legal assistants' fees, costs and expenses, from the non-prevailing party at all court levels.

By clicking the "I Agree" button, Referring Provider acknowledges that he or she has read and fully understands the terms, conditions, information and risks provided in this Referring Provider Acknowledgment.