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HCA ABCD Final
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07. July
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2022-07-19 10:00 AM - Commissioners' Agenda
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HCA ABCD Final
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Last modified
7/14/2022 1:23:51 PM
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7/14/2022 1:22:41 PM
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Meeting
Date
7/19/2022
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
d
Item
Request to Approve an Amendment to the Health Care Authority Access to Baby Dentistry
Order
4
Placement
Consent Agenda
Row ID
91496
Type
Agreement
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Toinformusthatyounolongerwishtoreceivefuturenoticesanddisclosuresinelectronicformatyoumay:i.declinetosignadocumentfromwithinyoursigningsession,andonthesubsequentpage,selectthecheck-boxindicatingyouwishtowithdrawyourconsent,oryoumay;ii.sendusanemailtotodd.stone@hca.wa.govandinthebodyofsuchrequestyoumuststateyouremail,fullname,mailingaddress,andtelephonenumber.Wedonotneedanyotherinformationfromyoutowithdrawconsent..Theconsequencesofyourwithdrawingconsentforonlinedocumentswillbethattransactionsmaytakealongertimetoprocess..RequiredhardwareandsoftwareTheminimumsystemrequirementsforusingtheDocuSignsystemmaychangeovertime.Thecurrentsystemrequirementsarefoundhere:https://SupporLdocusign.com/guides/signer-cuide-signing-system-requirements.AcknowledgingyouraccessandconsenttoreceiveandsigndocumentselectronicallyToconfirmtousthatyoucanaccessthisinformationelectronically,whichwillbesimilartootherelectronicnoticesanddisclosuresthatwewillprovidetoyou,pleaseconfirmthatyouhavereadthisERSD,and(i)thatyouareabletoprintonpaperorelectronicallysavethisERSDforyourfuturereferenceandaccess;or(ii)thatyouareabletoemailthisERSDtoanemailaddresswhereyouwillbeabletoprintonpaperorsaveitforyourfuturereferenceandaccess.Further,ifyouconsenttoreceivingnoticesanddisclosuresexclusivelyinelectronicformatasdescribedherein,thenselectthecheck-boxnextto'Iagreetouseelectronicrecordsandsignatures'beforeclicking'CONTINUE'withintheDocuSignsystem.Byselectingthecheck-boxnextto'Iagreetouseelectronicrecordsandsignatures',youconfirmthat:•YoucanaccessandreadthisElectronicRecordandSignatureDisclosure;and•YoucanprintonpaperthisElectronicRecordandSignatureDisclosure,orsaveorsendthisElectronicRecordandDisclosuretoalocationwhereyoucanprintit,forfuturereferenceandaccess;and•UntilorunlessyounotifyCloudPWROBOWashingtonStateHealthCareAuthority-SubAccountasdescribedabove,youconsenttoreceiveexclusivelythroughelectronicmeansallnotices,disclosures,authorizations,acknowledgements,andotherdocumentsthatarerequiredtobeprovidedormadeavailabletoyoubyCloudPWROBOWashingtonStateHealthCareAuthority-SubAccountduringthecourseofyourrelationshipwithCloudPWROBOWashingtonStateHealthCareAuthority-SubAccount.
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