Agenda 8-e - University of North Carolina Health Care System Electronic Medical Record System Access Agreement

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Exhibit A - 1 EMR SYSTEM ACCESS AGREEMENT EXHIBIT A I. CLIENT CONTACT INFORMATION Client: Client Contact: Company Name: ________________________ Name: _________________________ Billing Address: ________________________ Phone: ________________________ _______________________ Fax: __________________________ _______________________ E-Mail: _______________________ Billing Contact: (if different from Client Contact) Technical Contact: Name: _________________________________ Name: _________________________ Phone: _________________________________ Phone: ________________________ Fax: ___________________________________ Fax: __________________________ E-Mail: ________________________________ E-Mail: ________________________ Administrator/Privacy Officer: Name: _________________________________ Phone: _________________________________ Fax: ___________________________________ E-Mail: ________________________________ II. EMR SYSTEM A. EMR System Components: • EpicCare Ambulatory Clinical System • Resolute Professional Billing w/ Prelude Registration (Does not include physician billing services) • Cadence Scheduling • MyChart Patient Portal • Haiku for iPhone and Canto for iPad 19