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Welcome to RxScan's Perpetual Inventory Registration

Welcome to RxScan’s Perpetual inventory registration. Our Mission is to make it easy for hospitals and clinics to track medication throughout its lifecycle. Facilities are able to quickly and easily comply with the Joint Commission's recommendations on medication inventory control, record keeping and dispensing.

Before you begin using the application, we need to collect some information about you and your company. Please fill out the following forms, providing as much detail as possible. You will be able to review all of the information prior to submitting.

Click the continue button below when you're ready to start.

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Company Information

Business Name *
Address *
City *
State *
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Zip *
County
Country
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How many clinics are in your company? *
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How many years have you been in business? *
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Executive Contact

Title
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First Name *
MI
Last Name *
Position
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Address *
City *
State *
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Zip *
County
Country
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Phone *
Fax
Email *
Confirm Email *
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Secondary Contact

Title
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First Name *
MI
Last Name *
Position
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Address *
City *
State *
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Zip *
County
Country
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Phone *
Fax
Email *
Confirm Email *
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Billing Information

Title
Title
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First Name *
MI
Last Name *
Position
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Address *
City *
State *
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Zip *
County
Country
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Phone *
Fax
Email *
Confirm Email *
Federal Tax Id
Dun & Bradstreet #
PO #
Company Type *
In the past 36 months, has your company filed for protection or operated under federal / state bankruptcy laws (Chapter 11 or 7)? *
In the past 36 months, has any creditor filed or threatened to file a petition requesting the company be placed involuntarily into bankruptcy? *
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Initial User

Title
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First Name *
MI
Last Name *
Position
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Address *
City *
State *
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Zip *
County
Country
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Phone *
Fax
Email *
Confirm Email *
Username *
Time Zone *
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Confirmation

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Terms Of Use - Master Subscription Agreement

BY CLICKING THE "I ACCEPT" BUTTON DISPLAYED AS PART OF THE ORDERING PROCESS, YOU AGREE WITHOUT MODIFICATION TO THE FOLLOWING MASTER SUBSCRIPTION AGREEMENT (THE "AGREEMENT") GOVERNING YOUR USE OF RXSCAN, LTD.’s ONLINE SERVICES, INCLUDING ITS OFFLINE COMPONENTS. THIS AGREEMENT WILL BE EFFECTIVE AS OF THE DATE YOU CLICK THE "I ACCEPT" BUTTON BELOW OR THE DATE YOU BEGIN USING THE SERVICE, WHICHEVER IS EARLIER (THE "EFFECTIVE DATE"). IF YOU ARE ENTERING INTO THIS AGREEMENT ON BEHALF OF A COMPANY OR OTHER LEGAL ENTITY, YOU REPRESENT AND WARRANT THAT YOU (i) HAVE THE AUTHORITY TO BIND SUCH ENTITY TO THESE TERMS AND CONDITIONS, IN WHICH CASE THE TERMS "YOU" OR "YOUR" SHALL REFER TO SUCH ENTITY; (ii) THAT YOU HAVE READ AND UNDERSTAND THIS AGREEMENT; AND (iii) THAT YOU AGREE, ON BEHALF OF THE PARTY THAT YOU REPRESENT, TO THIS AGREEMENT. IF YOU DO NOT HAVE SUCH LEGAL AUTHORITY, OR IF YOU DO NOT AGREE WITH THIS AGREEMENT, YOU MUST SELECT THE "I DECLINE" BUTTON AND MAY NOT USE THE SERVICE.
** IMPORTANT **

Your application can not be processed without accepting the following Terms of Use - Master Subscription Agreement.Submission of this application does not guarantee acceptance by DrugSample.Org. Your application must be approved by us before access to the site is granted.

To view the Master Subscription Agreement in full, click here Terms of use.

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