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  • Diagnosis Live Logo

     

    Institution Profile

    Institution Name: *


    Department:


    Address Line 1: *


    Address Line 2:



    City: *
    State/Province: *
     
    Zip Code: *
     


    Country: *


    Number of Residents:

    4th Year:
    3rd Year:
    2nd Year:
    1st Year:
    How Many Campuses? *


    Key Personnel: (One person can fulfill multiple roles)

    Licenseea (The Department Chair or the Residency Program Director must be identified as the Licensee.)

    Department of Radiology Chairman  

    1. Licenseea -
                 

    Name: *
    Phone: *
    Email: *


    Residency Program Director

    1. Licenseea -
                 

    Name: *
    Phone *
    Email: *


    Primary Contact b(Used for correspondence and for contact person when a new resident wants to join.)


    Name: *
    Phone: *
    Email: *


    Account Administratorc


    Name: *
     
    Phone:*
     
    Email: *
     


    Technical Contactd


    Name: *
    Phone:*
    Email: *


    Review privacy policy* (check here to signify this document has been reviewed on RSNA.org/DiagnosisLive)

    * (check here to signify this document has been reviewed on RSNA.org/DiagnosisLive)

    * (check here to signify the technical requirements document has been shared with appropriate personnel)


    Your Questions or Comments:

     

    Licenseea: An authorized representative from the institution’s residency program must sign a license agreement.

    Primary Contactb: The primary contact will be the initial contact for users at their institution as well as RSNA inquiries relating to Diagnosis Live.

    Account Administratorc: The account administrator will invite users and designate permission levels.

    Technical Contactd: The technical contact will be contacted in the event of software updates or technical needs.

     

     

     

     

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