- I affirm that I have reached the age of eighteen (18) or am considered by law to be an adult for legal purposes in the jurisdiction where I reside and am “competent” to act on my own behalf.
- I understand that I may be subject to penalties under law for submitting false or misleading information in connection with my request to access the PFC Survivor Portal.
- I understand that I am requesting access to portions of my medical records/information for cancer treatment and recommendations for screening and management of long-term and/or late effects that may potentially arise as a result of my treatment (“Follow-up Care Plan”).
- I understand that to access the PFC Survivor Portal I must agree to the terms and conditions of the Passport for Care® Survivor Portal Use/Service Agreement.