\r\n
\r\n \r\n By checking the box below, I acknowledge that I am activating my\r\n account, and by my activation of the account, I agree and further\r\n certify that I possess the requisite authority to execute this\r\n document on behalf of my institution (“User”). I understand that\r\n Baylor Miraca Genetics Laboratory (BG) has agreed to allow (“User”)\r\n access to its online portal (“Portal”). User certifies that the unique\r\n email address(es) used to establish a new user's ordering provider's\r\n (“Provider”) access to the Portal has been assigned to the Provider by\r\n and is affiliated with User's institution. User certifies that it is\r\n legally permissible in Provider's jurisdiction for Provider to order\r\n the requested testing. User understands and warrants the NPI number\r\n utilized by Provider is accurate, belongs to Provider, and matches the\r\n ordering Provider's name, as registered with User. User certifies that\r\n Provider has been granted permission by User and is qualified to\r\n access to the portal. User understands and agrees that User is solely\r\n responsible for and shall immediately terminate Provider's access to\r\n the portal should Provider's affiliation with User terminate for any\r\n reason.\r\n \r\n \r\n
\r\n \r\n }\r\n label=\"I agree to the above terms and conditions\"\r\n />\r\n
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