PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS
The Client acknowledges that the Client takes full responsibility for the Clientís life and well-being, as well as the lives and well-being of the Clientís family and children (where applicable), and all decisions made during and after this program.
The Client expressly assumes the risks of the Program, whether or not such risks were created or exacerbated by the Practitioner. The Client releases the Practitioner, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders, employees, teachers, lecturers, agents, health Practitioners and staff (collectively, the Releasees) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releasees, the Client ever had, now has or will have in the future against the Releasees, arising from the Clientís past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Releasees.
CHOICE OF LAW, ARBITRATION AND LIMITED REMEDIES
This agreement shall be construed according to the laws of the State of California . In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. In the event a dispute arises between the parties, either arising from this Agreement or otherwise pertaining to the relationship between the parties, the parties will submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules). Any judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the Client in the event that an award is granted in arbitration is refund of the Program Fee. Without limiting the generality of the foregoing, no award of consequential or other damages, unless specifically set forth herein, may be granted to the Client.
If the terms of this Agreement are acceptable, please submit your signature below. By doing so, the Client acknowledges that: (1)he/she has received a copy of this letter agreement; (2)he/she has had an opportunity to discuss the contents with the Practitioner and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.
Client acknowledges that during the course of performing contracted services for the Client, the Practitioner may send health information electronically via email or other sources that may not be secure. If the Client does not approve of this method of transfer they must notify the Practitioner and a secure form of transmitting information will be established.
Jenn Culver Malecha (Practitioner) acknowledges that during the course of performing contracted services for the Client, the Practitioner may have access to, use, or disclose confidential health information. Practitioner hereby agrees to handle such information in a confidential manner at all times while providing services for the Client and after the services are completed, and commits to the following obligations:
- Practitioner will use and disclose confidential health information only in connection with and for the purpose of performing services.
- Practitioner will request, obtain, or communicate confidential health information only as necessary to perform services and shall refrain from requesting, obtaining, or communicating more confidential health information than is necessary to accomplish services.
- Practitioner will take reasonable care to properly secure confidential health information on any computer and will take steps to ensure that others cannot view or access such information. When away from workstations or when tasks are completed, Practitioner will log off computers or use a password-protected screensaver in order to prevent access by unauthorized users.
- Practitioner will not disclose personal password(s) to anyone without the express written permission of the Client, or record, or post it in an accessible location and will refrain from performing any tasks using another's password.
Practitioner understands that as an independently contracted service provider, the use and disclosure of Client information is governed by the rules and regulations established under HIPAA, the Health Insurance Portability and Accountability Act of 1996, and related policies and procedures. Therefore, with regard to participant information, Practitioner commits to the following additional obligations:
- Practitioner will use and disclose confidential health information solely in accordance with the federal and company policies set forth above or elsewhere. Practitioner also agree to familiarize with any periodic updates or changes to such policies in a timely manner.
- Practitioner will immediately report any unauthorized use or disclosure of confidential health information that become aware of to the Client in writing.
Practitioner also understands and agrees that failure to fulfill any of the obligations set forth in this Agreement and/or violation of any terms of this Agreement shall result in being subject to appropriate lawful action, up to and including, termination of services.