Account Reinstate

I, , account owner of , hereby authorize HelloNote (E Medical Records Live Inc.) to reactivate the HelloNote account for

I have the authority to make this decision.

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Signature Certificate
Document name: Account Reinstate
lock iconUnique Document ID: a96ce6123b139aa28d52e3ab64b15d02606de0ef
Timestamp Audit
January 28, 2022 12:50 pm EDTAccount Reinstate Uploaded by HelloNote EMR - hello@hellonote.com IP
March 10, 2022 5:57 pm EDTDonna Dadivas - Donna@hellonote.com added by HelloNote EMR - hello@hellonote.com as a CC'd Recipient Ip: