Legal Consent Records

LEGAL CONSENT RECORDS

This Legal Consent Records Agreement (the "Agreement") is entered into as of Date: by and between Client Name: ("Consenting Party") and Organization Name: ("Authorized Recipient"). The Consenting Party and Authorized Recipient are each a "Party" and collectively the "Parties."

RECITALS

WHEREAS, the Parties contemplate the creation, collection, storage and use of certain recordings and records concerning the Consenting Party for the purposes set forth below; and

WHEREAS, the Consenting Party desires to grant a limited, revocable authorization permitting the Authorized Recipient to create, retain and, to the extent authorized herein, disclose such records in accordance with the terms, limitations and safeguards contained in this Agreement; and

WHEREAS, the Authorized Recipient agrees to create, maintain and, where authorized below, disclose such records in compliance with applicable law and the terms of this Agreement.

NOW THEREFORE, in consideration of the mutual covenants and promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

1. DEFINITIONS

1.1 "Records" means audio recordings, video recordings, written notes, photographs, electronic files, medical records, and other documentary material created, collected or maintained by the Authorized Recipient that relate to the Consenting Party as specified in Section 2.

1.2 "Use" means internal review, treatment, administration, quality assurance, training, research (subject to de-identification where required by law), and other purposes expressly enumerated in Section 4.

2. CONSENT TO CREATION AND TYPES OF RECORDS

The Consenting Party hereby authorizes the Authorized Recipient to create and maintain the following types of Records (select all that apply):

Audio recordings Video recordings Written notes/documents

Electronic files Medical/health records Photographs/images

3. SCOPE, PURPOSE AND RECIPIENTS

The Authorized Recipient shall not disclose Records to any person or entity other than those recipients explicitly identified above, except as required by law or with prior written authorization from the Consenting Party.

4. DURATION; EFFECTIVE DATE; REVOCATION

This Consent is effective as of Effective Date: and shall remain in effect until Expiration Date: , unless earlier revoked in accordance with this Section.

Revocation must be submitted in writing to the Authorized Recipient at the address for Notices set forth in Section 10. Revocation shall not affect disclosures made in reliance on this Consent prior to receipt of the revocation.

5. RECORDS RETENTION, SECURITY AND DESTRUCTION

The Authorized Recipient shall maintain administrative, technical and physical safeguards appropriate to the sensitivity of the Records and in accordance with applicable law. Where Records contain health information, the Authorized Recipient shall apply protections consistent with applicable health information privacy laws.

6. THIRD-PARTY ACCESS AND REDISCLOSURE

Any third party receiving Records from the Authorized Recipient shall be informed of the confidentiality and limited-use restrictions and shall be required to afford protections substantially comparable to those in this Agreement prior to any disclosure. The Authorized Recipient remains responsible for any unauthorized redisclosure by such third party to the extent permitted by law.

7. REPRESENTATIONS, WARRANTIES AND ACKNOWLEDGMENTS

The Consenting Party represents that they are at least 18 years of age or, if signing as a parent or legal guardian, has the authority to provide this Consent on behalf of the minor or incapacitated person identified above. The Consenting Party acknowledges that they have read and understand the scope and effect of this Consent and that no promises, assurances or representations other than those set forth in this Agreement have been made to induce the execution of this Consent.

8. INDEMNIFICATION; LIMITATION OF LIABILITY

The Consenting Party agrees to indemnify and hold harmless the Authorized Recipient from any claims, liabilities or expenses arising from false representations by the Consenting Party concerning authority to grant this Consent. Except to the extent caused by willful misconduct or gross negligence, neither Party shall be liable to the other for consequential, incidental or punitive damages arising from the performance of obligations under this Agreement.

9. NOTICES

Notices shall be deemed given when received in writing at the addresses provided above or at any other address a Party designates in writing pursuant to this Section.

10. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment or modification of this Agreement must be in writing and signed by both Parties. No waiver of any provision shall be effective unless in writing signed by the Party granting the waiver. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

11. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction indicated below without regard to conflict of laws principles.

This Agreement constitutes the entire agreement of the Parties with respect to the subject matter hereof and supersedes all prior understandings, agreements and communications, whether written or oral. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

12. CERTIFICATION AND ACKNOWLEDGMENT

By signing below, the Consenting Party certifies that they have read this Agreement, understand its terms, and knowingly and voluntarily authorize the collection, use, retention and disclosure of Records as set forth herein. The Authorized Recipient certifies that it will comply with the terms of this Agreement and applicable law.

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