I certify that I am an authorized user of the Informatics Center and have been granted
access to the Informatics Center for purposes of providing patient care, or conducting
quality assessment and improvement activities, including case management or care
coordination, in connection with programs sponsored by a North Carolina Community
Care Network or the North Carolina Department of Health and Human Services.
I certify that any patient for whom I am requesting information is a current or
prospective patient of mine or my employer, or that I am providing patient care or
conducting quality assessment or improvement activities that may include case management or
care coordination, in connection with one or more health care quality initiative programs
sponsored by Community Care of North Carolina or the North Carolina Department of Health and Human Services.
I understand that inappropriate access to or disclosure of this information is a violation of state and/or
federal law and may result in disciplinary action by my licensing board and/or revocation of
Informatics Center access privileges.
Disclaimer: Information obtained from the Informatics Center may contain errors or omissions.
Additional independent verification of the content and/or accuracy of the information may be prudent or necessary.