"*" indicates required fields

NOTE: THIS AGREEMENT MUST COMPLY WITH APPLICABLE STATE LAW

I understand that Pediatric People, PLLC has a legal and ethical responsibility to maintain patient privacy, including obligations to protect the confidentiality of patient information and to safeguard the privacy of patient information of any Organization we work with.

I understand that Pediatric People, PLLC has a legal and ethical responsibility to maintain the confidentiality, integrity, and accessibility of protected health information of each Organization we work with, whether such information is maintained in hard copy or electronic format.

In addition, I understand that during the course of my relationship with Pediatric People, PLLC, I may see or hear other confidential information, such as business and financial data and operational information pertaining to an Organization we work with that Pediatric People, PLLC is obligated to maintain as confidential.

In addition, I understand that during the course of my relationship with Pediatric People, PLLC, I may see or hear other confidential information of Pediatric People, PLLC, such as business and financial data and operational information that must remain confidential. Pediatric People, PLLC confidential information includes, but is not limited to, client and vendor names and contact information, or project names, business and operational techniques, processes and know-how, as well as specific product, service and customer development information.

In addition, I understand that during the course of my relationship with Pediatric People, PLLC, I may have access to databases or other client information that is confidential including names, addresses and contact information. I may not reproduce these databases or copy them in any way. I may not keep this information on any personal computers or storage media. Any Pediatric People, PLLC related phone numbers on personal cell phones must be labeled as an Pediatric People, PLLC contact.

As a condition of my relationship with Pediatric People, PLLC, I understand that I must sign and comply with this agreement.

By signing this document I understand and agree that:

I will use and disclose Patient Information and/or confidential information only if such disclosure complies with Pediatric People, PLLC policies and only to the extent such use or disclosure is required for the performance of my job.

My personal access code(s), user ID(s), access keys), and passwords) used to access computer systems or other equipment are to be kept confidential at all times.

I will not access or view any information other than that which is required for me to do my work with Pediatric People, PLLC. If I have any question about whether access to certain information is required for me to do my work with Pediatric People, PLLC, I will immediately ask for clarification.

I will not use e-mail to transmit patient information unless I am instructed to do so by the Privacy Officer.

I will log off of the computer as soon as I have finished using it.

I will not discuss any information pertaining to an organization or its patients in an area where unauthorized individuals may hear such information (for example, in hallways, on public transportation, at restaurants, and at social events or with my family members). I understand that it is not acceptable to discuss any organizational information in public areas even if specifics such as a patient's name are not used.

I will not make inquiries about any Pediatric People, PLLC information for any individual or party who does not have proper authorization to access such information.

I will not make any unauthorized transmissions, copies, disclosures, inquiries, modifications, or purging of patient information or confidential information (in any form or media). Such unauthorized transmissions include, but are not limited to, removing and/or transferring patient information or confidential information from Pediatric People, PLLC computer system to unauthorized locations. I will not remove laptops from the premises of Pediatric People, PLLC.

I will not make any unauthorized transmissions, copies, disclosures, inquiries, modifications, or purging of client information, vendor information or Pediatric People, PLLC written or cloud materials. Such unauthorized transmissions include, but are not limited to, removing and/or transferring (in any form or media) client information or Pediatric People, PLLC written, cloud materials or information from Pediatric People, PLLC domain to unauthorized locations such as a personal computer hard drive, an external hard drive, or other storage media.

OPTIONAL AND SUBJECT TO STATE LAW: During the period of my relationship with Pediatric People, PLLC, and for twenty-four (24) months thereafter, I will not, for myself or on behalf of any other person or entity, in any way compete with the business then done or intended to be done by Pediatric People, PLLC, including calling upon any customer of Pediatric People, PLLC for the purpose of soliciting or providing to such customer any products or services which are the same as or similar to those provided or intended to be provided by Pediatric People, PLLC. Customers of Pediatric People, PLLC shall include customers of Pediatric People, PLLC existing upon the termination of my working relationship with Pediatric People, PLLC, all former customers of Pediatric People, PLLC and all potential customers contacted or solicited by Pediatric People, PLLC during the period of my working relationship with Pediatric People, PLLC.


OPTIONAL AND MAY BE SUBJECT TO STATE LAW: I further agree that all products, processes, know-how, inventions or devices, or any improvements to any of the foregoing ("Inventions"), discovered or developed during the course of my working relationship with Pediatric People, PLLC which are (a) related to Pediatric People, PLLC's business (b) in the course of development by Pediatric People, PLLC or (c) made with the use of Pediatric People, PLLC's time, materials or facilities, shall, in each case, belong ot Pediatric People, PLLC. I hereby assign and transfer to Pediatric People, PLLC all right, title and interest to any and all such Inventions. I agree promptly to disclose to Pediatric People, PLLC all such Inventions, whether patentable or not. I agree to execute such instruments and assignments and to take such other action, at Pediatric People, PLLC's expense, as may be necessary or desirable to vest title in such Inventions to Pediatric People, PLLC or to obtain letters patent and copyrights for the benefit of Pediatric People, PLLC.

Upon termination of my work relationship with Pediatric People, PLLC, I will immediately return to Pediatric People, PLLC all Pediatric People, PLLC property (e.g. keys, documents, ID badges, etc.) and Pediatric People, PLLC documents and information and remove any client or vendor contact information from my personal phone.

SUBJECT TO STATE LAW: In the event of a breach or threatened breach of any of the terms of this Agreement, Pediatric People, PLLC shall be entitled to an injunction restraining me from committing any breach of this Agreement without showing or proving any actual damages and without diminishing any other right or remedy which Pediatric People, PLLC may have at law or in equity to enforce the provisions of this Agreement. I waive any right I may have to require Pediatric People, PLLC to post a bond or other security with respect to obtaining or continuing any injunction or temporary restraining order and, further, release Pediatric People, PLLC and its officers and directors from and waive any claim for damages against them which I may have with respect to Pediatric People, PLLC obtaining any injunction or restraining order pursuant to this Agreement.

This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors, assigns, legal representatives, heirs and distributes. This Agreement shall be governed by and construed in accordance with the laws of the State of Texas. If any restrictions on me shall for any reason be held by a court of competent jurisdiction to be excessively broad as to duration, activity or subject, such restriction shall be construed so as to be limited or reduced to be enforceable to the extent compatible with applicable law as it shall then appear, it being understood that by the execution of this Agreement the parties hereto regard the restrictions contained herein as reasonable and compatible with their respective rights. Subject to the prior sentence, the total invalidity or unenforceability of any provision in this Agreement shall not affect any other provision hereof, and this Agreement shall be construed as if such invalid or any unenforceable provision were omitted.

Pediatric People
01/2014
Employee/Physician/Student/Volunteer Name*
Clear Signature