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| 1700
South Tamiami Trail |
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| Sarasota, FL 34239-3555 |
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| VENDOR
PACKAGE ACCEPTANCE FORM |
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| I have received the Vendor Registration Package, have thoroughly
reviewed it’s contents and agree to comply with all policies and procedures
as established by Sarasota Memorial Hospital and to be compliant with state
and federal privacy regulations enclosed in this package. |
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| I
completely understand that failure to comply with these policies and
procedures will affect my ability to do business with Sarasota Memorial
Hospital as spelled out in Policy #00.PUR.22. |
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| _______________________________ |
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| Name
(printed) |
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| _______________________________ |
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| Signature |
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| _______________________________ |
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| Company
Name |
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| _______________________________ |
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| Date |
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