CONSENT STATEMENT - CONTACT INFORMATION
JEFFERSON RELEASE POLICY – PLEASE READ CAREFULLY
Jefferson may record/livestream/photograph this Conference. These images/recordings, along with your name, may be used in Jefferson publications or on the Jefferson website. If you verbally submit any questions for Q&A sessions, you are agreeing to be recorded and to have that recording available in enduring materials. Once photographed, filmed, recorded, or videotaped, you waive any right of inspection or approval to which such images/recordings may be put and Jefferson has the right to use, publish, reproduce, modify, adapt and distribute at any time in any manner or medium.
I understand that it is my right to withhold consent to these Jefferson policies, or to withdraw my previous consent at any time. I further understand that, without my consent, it is not possible to process my course registration request.
Please contact the Jefferson Office of Continuing Professional Development at 215-955-6992 if you have any questions.
JEFFERSON HIPAA POLICY – PLEASE READ CAREFULLY
I understand that, as an attendee of this Conference hosted by Thomas Jefferson University, Jefferson University Physicians and Thomas Jefferson University Hospitals, Inc. (collectively “Jefferson”), I may gain access to certain proprietary information (“Confidential Information”), including Protected Health Information (“PHI”).
I agree to maintain the confidentiality of all Confidential Information, including PHI, obtained from any source. I agree that I will take all necessary steps to protect such Confidential Information and shall not directly or indirectly disclose or use it in any manner or for any reason, other than as necessary to complete the Conference.
In furtherance of the above, I agree not to take photographs, record in any manner or otherwise reproduce any such Confidential Information. I understand that any unauthorized use or disclosure of Confidential Information by the undersigned may result in possible legal action against me by Jefferson whose confidentiality is breached.
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