confidentiality agreement


	CONFIDENTIALITY AGREEMENT Liposuction 101 Contact Information: For questions or additional information, please contact: Atoussa Cameron, RN, FNP Course Coordinator Email: atoussa@jeffreykleinmd.com Tel: (949) 248-1632, ext. 210 Fax: (949) 248-9339 As a condition of attending the Liposuction 101 course, physicians, nurses, and medical assistants must agree to respect the confidentiality of the following items: Patient identity or information Clinical protocols Financial information Employee data including benefits and compensations data Policies and procedures Forms Internal business processes and procedures Under no circumstances shall an attendee disclose information received, including specific patient information, business practices, marketing strategies, patient list, clinical protocols (except to describe procedures for patient education purposes), information systems, or policies and procedures. Under no circumstances shall an attendee use patient photographs, or use the name of Jeffrey Klein in advertising or use audio or video devices to record clinical procedures or discussions in association with the course. ________________________________________________________ Signature of Attendee & Date _______________________________________ Printed Name of Attendee