AGREEMENT CONT. 6 Within 30 days of termination, cancellation, expiration, or other conclusion of this Agreement, or within 30 days of a request by District with regard to any portion of the data, Independent Contractor shall return to District or if return is not feasible, destroy and not retain any copies of any and all Confidential Information that is in possession of Independent Contractor and certify in writing that all copies of the confidential information in its possession have been destroyed. This requirement shall not apply, and Independent Contractor may retain, personally identifiable student data if Independent Contractor has obtained written consent of the student's parent or guardian (or from the student if 18 or older or emancipated) and provides documentation of that consent to the District.
AGREEMENT CONT m. To be aware that although you will have exclusivity for your agreed category within the room -= due to the nature of our Facebook Group being available and open to all members in all groups – that a competitor from another group may be present.
AGREEMENT CONT. I understand that the individual’s capacity for consent will be reviewed as the persons condition warrants or every six months to assess the continued need for an Authorized Representative; • I am aware that providers, in an emergency, may initiate, administer, or undertake a proposed treatment without my consent or the consent of the above individual. I will be notified immediately of the provision of treatment without my consent that occurred in an emergency; • I understand that treatment may be provided without my consent in accordance with a court order or in accordance with other provisions of law that authorize such treatment including the Health Care Decisions Act (54. 1-2981 et seq.). On behalf of the individual I represent, I may request admission to or discharge from any medical treatment at any time that requires informed consent; • I will be notified if the individual I represent objects to the disclosure of specific information or a specific proposed treatment or if the individual disagrees with a decision I have made that requires informed consent. As required by the Human Rights Regulations, the Human Rights Advocate will be notified and a petition for a LHRC review may also be filed under 12 VAC 00-000-00; • At any time I determine that I am unable to continue to represent the above individual, I will provide written notice to the Case Manager or Clinician; Permission from the Authorized Representative is not necessary for Case Management Services, Day Treatment or Day Support Services, (unless medical therapies are part of the treatment plan); Employment Services, (Psychotherapy or Outpatient) therapies, etc. provided by Henrico Area Mental Health and Retardation Services staff, except if authorization for release of information is required. I understand and accept the responsibility of becoming an Authorized Representative as outlined in the Human Rights Regulations, 12 VAC 00-000-00. I have received a copy of the Henrico Area Human Rights Responsibilities Brochure and the Privacy Notice. Signature of Authorized Representative Date Daytime Phone #: Address: I agree to the recommended appointment of the above Authorized Representative:
AGREEMENT CONT. 6 Within 30 days of a request by District with regard to any portion of the data, Independent Contractor shall return to District or if return is not feasible, destroy and not retain any copies of any and all Confidential Information that is in possession of Independent Contractor and certify in writing that all copies of the confidential information in its possession have been destroyed. This requirement shall not apply, and Independent Contractor may retain, personally identifiable student data if Independent Contractor has obtained written consent of the student's parent or guardian (or from the student if 18 or older or emancipated) and provides documentation of that consent to the District. The obligations of this Agreement shall not apply to any information which (a) is already in the public domain through no breach of this Agreement, 7 including but not limited to information available through schools' web site(s); (b) was lawfully in Independent Contractor's possession prior to receipt from an District school, its faculty staff or students; or (c) is received by Independent Contractor independently from a person or entity free to lawfully disclose such information other than an District school, its faculty, staff, or students. Independent Contractor warrants and represents that it shall, at all times, comply with the terms of this Agreement and with FERPA GRAMA, and the Utah 8 Student Data Protection Act and further agrees not to disclose or re-disclose to any person or entity for any purpose whatsoever any personally identifiable student information as that term is defined by this agreement, FERPA, GRAMA, or the Utah Student Data Protection Act. Independent Contractor agrees that District or its designee may, upon request, during business hours and at the District's sole expense, audit Independent 9 Contractor with respect to this Agreement to verify compliance with the Agreement and with the applicable requirements of law. The undersigned representative of Vendor represents and warrants that he or she is authorized to sign this Agreement on behalf of Vendor and to bind 10 Vendor to the covenants of this Agreement. This Agreement may not be modified except by the written consent of the district.
