HIPAA MDS² Document Access Request

Please complete the information on this form and click Submit. You will then be directed to the website containing the MDS² security documents.

Philips Healthcare respects your privacy and believes strongly in protecting the privacy of the personally identifiable information you share with us - you can review our full privacy policy here.

* Indicates required field.

PERSONAL INFORMATION

* First Name
*Last Name
Occupation
Company/Institution
Department
Hospital/Clinic
*Address
Address 2
*City
*State
*Post/Zip
Telephone
*Email

AUTHORIZATION

Philips Medical Systems grants a license to persons authorized to access the MDS² Library to make electronic and paper copies of the MDS² forms therein, exclusively for the purpose of evaluation the security features of Philips Medical Systems products for purchase or as part of its internal security program.

QUESTIONS

* 1. Access to the Philips Healthcare MDS² Library is limited to users of Philips Healthcare products and prospective purchasers for the purpose of evaluating the security features of the products.
I meet these access requirements

* 2. Please keep me up to date with information relating to the security of Philips Healthcare products and services.
Yes
No

* 3. Customer consents to contact by Philips Healthcare relating to a prior purchase of a Philips Healthcare product or service.
Yes
No

Submit

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