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HCA Amendment Signed
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2022
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07. July
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2022-07-19 10:00 AM - Commissioners' Agenda
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HCA Amendment Signed
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Last modified
7/25/2022 8:11:19 AM
Creation date
7/25/2022 8:10:52 AM
Metadata
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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
Fully Executed Version
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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To inform us that you no longer wish to receive future notices and disclosures in electronic <br />format you may: <br />i. decline to sign a document from within your signing session, and on the subsequent page, <br />select the check-box indicating you wish to withdraw your consent, or you may; <br />ii. send us an email to todd.stone@hca.wa.gov and in the body of such request you must state <br />your email, full name, mailing address, and telephone number. We do not need any other <br />information from you to withdraw consent.. The consequences of your withdrawing consent for <br />online documents will be that transactions may take a longer time to process.. <br />Required hardware and software <br />The rninimum system requirements for using the DocuSign system may change over time. The <br />cuffent system requirements are found here: https://support.docusign.com/guides/signer-guide- <br />si gnin s-system-requ irem ents. <br />Acknowledging your access and consent to receive and sign documents electronically <br />To confirm to us that you can access this information electronically, which will be similar to <br />other electronic notices and disclosures that we will provide to you, please confirm that you have <br />read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for <br />your future reference and access; or (ii) that you are able to email this ERSD to an email address <br />where you will be able to print on paper or save it for your future reference and access. Further, <br />if you consent to receiving notices and disclosures exclusively in electronic format as described <br />herein, then select the check-box next to 'I agree to use electronic records and signatures' before <br />clicking'CONTINUE' within the DocuSign system. <br />By selecting the check-box next to 'I agree to use electronic records and signatures', you confirm <br />that: <br />. You can access and read this Electronic Record and Signature Disclosure; and. You can print on paper this Electronic Record and Signature Disclosure, or save or send <br />this Electronic Record and Disclosure to a location where you can print it, for future <br />reference and access; and. Until or unless you notify CloudPWR OBO Washington State Health Care Authority-Sub <br />Account as described above, you consent to receive exclusively through electronic means <br />all notices, disclosures, authorizations, acknowledgements, and other documents that are <br />required to be provided or made available to you by CloudPWR OBO Washington State <br />Health Care Authority-Sub Account during the course of your relationship with <br />cloudPWR oBo washington State Health care Authority-Sub Account.
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