Barco MediCal QAWeb - QAWeb Facility Signup

QAWeb Facility Signup

All fields are required

Facility information

Facility name:
Service provider code:	Don't have a service provider code?
Street and number:
Zip:
City:
State:
Country:
Language:
Time zone:

Facility administrator contact information.

First name:
Last name:
Phone number:
Email:
Enter your email again:

Facility administrator username and password.

Choose a username:
Choose a password:
Re-enter your password:

Facility invoicing contact information

First name:
Last name:
Phone number:
Email:
Enter the email again:

Radiology manager contact information

First name:
Last name:
Phone number:
Email:
Enter the email again:

The data are collected in a database for contacting purposes only. The information in this database will be accessible by User, Service Provider and Barco solely for the purpose of well operating the QAWeb system and shall be treated by them as confidential and/or legally privileged information. Information in the database will not be shared, disclosed, distributed or otherwise transferred to a third party. You have the right to access and, if necessary, correct your personal data.