Client Confidential Records Acceptance Form

Client Confidential Records Acceptance Form

RECITALS

WHEREAS, Client Name: (the "Client") possesses certain confidential records and materials described below that are necessary for the Recipient to perform services; and

WHEREAS, Recipient Name: (the "Recipient") agrees to accept, safeguard, and return or properly dispose of such confidential records in accordance with the terms of this Acceptance Form; and

WHEREAS, the parties desire to document the condition, custody, permitted uses, compensation (if any), and legal obligations related to the transfer and handling of such confidential records.

SCOPE OF WORK / PURPOSE

The Recipient shall receive and maintain the confidential records described below solely for the purpose stated and shall not use the records for any other purpose without the Client's prior written consent.

DESCRIPTION OF RECORDS

The Client hereby delivers to the Recipient the following confidential records. The Recipient acknowledges receipt and condition of the records as recorded in the chain of custody.

Hard copy Electronic files Encrypted / password protected Sealed envelope(s)

CHAIN OF CUSTODY / RECEIPT

The following records the initial transfer event and subsequent custody transfers. Each transfer must be recorded with the name, organization, and date.

Month   Day   Year

CONDITION OF RECORDS & HANDLING REQUIREMENTS

The Recipient confirms the records were delivered in the condition described below and agrees to handle, store, and transport the records using industry-standard physical and technical safeguards appropriate to the sensitivity of the records.

PAYMENT TERMS

If applicable, the Client agrees to compensate the Recipient as set forth below for services rendered in connection with the handling, storage, or processing of the records.

TERM AND TERMINATION

This Acceptance Form shall commence on the Start Date and continue until the End Date or until the records are returned or destroyed in accordance with this Form, unless earlier terminated as provided below.

Start Date: Month Day Year

End Date: Month Day Year

Upon termination or at the Client's written direction, the Recipient shall, at the Client's option, return all originals and copies or securely destroy all records and certify in writing that destruction has been completed.

CONFIDENTIALITY

The Recipient acknowledges that the records are Confidential Information. The Recipient shall: (a) use the Confidential Information solely for the permitted purpose set forth in this Form; (b) limit access to persons who have a legitimate need to know and who are bound by confidentiality obligations at least as restrictive as those in this Form; (c) implement and maintain reasonable administrative, physical, and technical safeguards to protect the Confidential Information from unauthorized access, use, disclosure, alteration, or destruction; and (d) not disclose Confidential Information to any third party except with the Client's prior written consent or as required by law, in which case the Recipient shall, to the extent permitted, provide prior notice to the Client and cooperate to protect privilege.

The confidentiality obligations shall survive termination or expiration of this Acceptance Form for a period of five (5) years or for the maximum period permitted by applicable law if longer.

LIABILITY AND INDEMNITY

The Recipient shall be liable for loss, theft, or unauthorized disclosure of the records resulting from the Recipient's failure to exercise the required standard of care. The Recipient agrees to indemnify, defend, and hold the Client harmless from any third-party claims, damages, or liabilities arising from a breach of the Recipient's obligations under this Form, except to the extent caused by the Client's gross negligence or willful misconduct.

GOVERNING LAW

This Acceptance Form shall be governed by and construed in accordance with the laws of the State of without regard to its choice-of-law rules.

ENTIRE AGREEMENT

This Acceptance Form, together with any written schedules or attachments signed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, and communications, whether written or oral. Any amendment to this Acceptance Form must be in writing and signed by authorized representatives of both parties.

ACKNOWLEDGMENT AND CERTIFICATION

By signing below, the undersigned representatives certify that they are authorized to bind their respective parties, that they have reviewed the foregoing description of records and terms, and that the Recipient accepts custody of the confidential records subject to the obligations and limitations set forth in this Acceptance Form.

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