|User Name:||* User name is required.|
|Password:||* Password is required.|
By checking this box you agree that your use of the MDinsight® web site constitutes a representation that you have been authorized to receive access to protected health information (PHI) as defined under the Health Insurance Portability and Accountability Act (HIPAA) on behalf of a healthcare provider, clinician or other covered entity. You also agree to limit your access to and use of PHI to the minimum necessary to perform an authorized function or inquiry related to treatment, payment or health care operations. Any misrepresentation of your status as a healthcare provider, clinician or an Insurer employee may result in the immediate termination of access rights, as well as the filing of a complaint with the Office of Civil Rights, the governing authority over HIPAA. You agree to notify us immediately of any breach or potential breach of the secrecy of your login information or any unauthorized access of the Portal, by e-mail to email@example.com.