By completing and submitting the form above, I authorize QS/1 to enroll the below Pharmacy in the Updox service ("Service").
- This Service requires QS/1 to collect data, including Protected Health Information, from Pharmacy and securely transmit it to Updox.
- I further attest and affirm that I am authorized to sign this Authorization on behalf of the Pharmacy. Pharmacy will notify QS/1 in writing if it desires to terminate Services.