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ACCESS TO SE HEALTH - @YOURSIDE COLLEAGUE®

Confidentiality Agreement

Instructions:

  • Complete the form by filling in the required information.
  • Carefully read and accept the statements of understanding.
  • Click on the SUBMIT button to send the form.
  • If you need assistance or have questions, please contact the SE Health FNIM Program at 1-800-463-1763 Ext. 142971. You can also email atyoursidefni@sehc.com.

This form is to be completed by the person who is requesting access to SE Health technology application, @YourSide Colleague®. Items marked with a red asterisk (*) are required.