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HIPAA Privacy and Security Statement

Username: Required - (Choose a username that would not identify you personally. i.e, avoid using a nickname that you might use in real life.)
First Name: Not required, but recommended.
First letter of Last Name: Optional
Email: Not Required, but recommended and only if the email address does not identify you by name.
Password: Required
Phone (primary): Optional
Phone (secondary): Optional
Street Address: Optional
City: Optional
State: Optional - Ex: (UT, CA)
Zip: Optional
Authorization Code: Required
Date of Birth: Format: mm/dd/yyyy
Personal Profile:         

HIPAA Notice: In order to remain HIPAA compliant, this service does not require you to submit any information that might identify you specifically or personally. If you choose to fill in 'Optional' fields you are stating that the system may store or transmit that information for educational, or other data aggregation. The HRP impliments robust privacy and transmition protocals.

I have read the HIPAA Privacy and Security Statement , and agree to the terms of service.