Sumpter v. Crittenden Hospital Association et al
Filing
49
ORDER directing plaintiffs to file a consolidated amended complaint by 9 February 2015. The stay will dissolve on 10 February 2015. Defendants must answer or otherwise respond by 11 March 2015. The motion for class certification, or a stipulation, is due by 30 June 2015. Phase 1 discovery, focusing on class issues and the merits, will end on 18 September 2015. The Court will hold another status conference in August or September. Trial is set for 8 February 2016. A Final Scheduling Order will iss ue. An amended Order with all pretrial deadlines will issue after the Court sees where the case stands in September. The Court approves the proposed protective Orders with a few changes attached hereto. Signed by Judge D. P. Marshall Jr. on 1/21/2015. (jak)
IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JONESBORO DIVISION
DELORIS SUMPTER
v.
PLAINTIFF
No. 3:14-cv-229-DPM
CRITTENDEN HOSPITAL
ASSOCIATION, ET AL.
DEFENDANTS
RHONDA MICHELLE GOODFELLOW,
on behalf of herself and all similarly situated
persons
v.
PLAINTIFF
No. 3:14-cv-226-DPM
EUGENE K. CASHMAN, JR., ET AL.
DEFENDANTS
ORDER
The Court held another status conference on 21 January 2015. The stay
has served its purpose. Here's the schedule. A consolidated amended
complaint is due by 9 February 2015. The stay will dissolve on 10 February
2015. Defendants must answer or otherwise respond by 11 March 2015.
Formal discovery can start after that date. The motion for class certification,
or a stipulation, is due by 30 June 2015. Phase 1 discovery, focusing on class
issues and the merits, will end on 18 September 2015. The Court will hold
another status conference in August or September. Trial is set for 8 February
2016. A Final Scheduling Order will issue. An amended Order with all
pretrial deadlines will issue after the Court sees where the case stands in
September. The Court approves the proposed protective Orders with a few
changes. See attached.
So Ordered.
P.
D.P. Marshall J
United States District Judge
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r=vov..y
~0 I (
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JONESBORO DIVISION
DELORIS SUMPTER, ET AL.,
Plaintiff,
v.
)
)
)
)
)
Case No. 3:14-cv-00229-DPM
)
CRITTENDEN HOSPITAL ASSOCIATION,
GENE CASHMAN, DAVID RAINES, BRAD
MCCORMICK, CIGNA HEALTH AND LIFE
INSURANCE CO. AND CIGNA CORPORATION,
Defendants.
RHONDA MICHELLE GOODFELLOW,
on behalf of herself and all similarly situated
persons,
Plaintiffs,
v.
)
)
)
)
)
)
)
)
)
)
)
)
)
EUGENE K. CASHMAN, JR.; JAMIE R.
CARTER, JR.; DAVID G. BAYTOS;
DAVID RAINES, JR.; W. BRAD
MCCORMICK; JASON W. COLLARD;
HERSCHEL F. OWENS; ANDREW
LUTTRELL; DONNA B. LANIER;
CAROL C. MCCORMACK; KEITH M.
INGRAM; RANDALL CATT; DAVID
FORD; THOMAS F. DONALDSON, JR.;
WILLIAM JOHNSON; LANNIE L.
LANCASTER; JULIO P. RUIZ; SHERRY
L. LONDON; NESS S. SECHREST;
RANDY R. SULLIVAN; LEVEN
WILLIAMS; SIMPLIFI HEALTH
BENEFIT MANAGEMENT, LLC; and
CIGNA HEALTH AND LIFE
INSURANCE COMPANY,
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Defendants.
Removed from the Circuit Court
of Crittenden County, Arkansas,
No. CV-2014-303
)
Case No. 3:14-cv-00226-DPM
AGREED CONFIDENTIALITY ORDER
The parties have agreed to the terms of this Order, and the Court finds it appropriate and
in accordance with Federal Rule of Civil
Procedure ~ 26(c).
Therefore, the Court orders
as follows:
1.
Scope.
All materials that are produced in the course of discovery, including
initial disclosures, responses to discovery requests, deposition testimony and exhibits, and
information derived from the foregoing materials (collectively "documents"), are governed by
this Order to the extent they are designated Confidential Information by the producing party.
2.
Confidential Information. As used in this Order, "Confidential Information"
means information designated as "CONFIDENTIAL" by the producing party that falls within
one or more of the following categories:
(a) information whose disclosure is prohibited or
restricted by statute or regulation; (b) information that reveals trade secrets, including proprietary
information and documents covered by FRCP 26(c)(l)(G); (c) research, technical , commercial or
financial information that the party has maintained as confidential, including documents related
to nonpublic financial forecasts, sales, pricing, premiums, fees, commissions, and revenues; (d)
personal identity information; (e) income tax returns (including attached schedules and forms),
W-2 forms and 1099 forms; or (f) personnel or employment records of a person who is not a
party to the case.
Information or documents that are available to the public may not be
designated as Confidential Information.
3.
Designation.
(a)
A party may designate a document or material as Confidential Information
for protection under this Order by affixing the words "CONFIDENTIAL" on the document and
on all copies in a manner that will not interfere with the legibility of the document. "Copies"
includes electronic images, duplicates, extracts, summaries or descriptions that contain the
2
Confidential Information. The marking "CONFIDENTIAL" shall be applied before or at the
time of the documents are produced or disclosed . Applying the marking "CONFIDENTIAL" to
a document does not mean that the document has any status or protection by statute or otherwise
except to the extent and for the purposes of this Order.
Any copies that are made of any
documents marked "CONFIDENTIAL" shall also be so marked, except that indices, electronic
databases or lists of documents that do not contain substantial portions or images of the text of
marked documents and do not otherwise disclose the substance of the Confidential Information
are not required to be marked.
(b)
The designation of a document as Confidential Information is a
certification by an attorney or a party appearing pro se that the document contains Confidential
Information as defined in this order.
4.
Depositions. Any deposition testimony taken in this case shall not be treated as
Confidential Information or entitled to protection under this order unless the party seeking to
have deposition testimony treated as Confidential Information does the following: If during the
course of a deposition a witness is shown protected information or is asked about protected
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information, within a r~onaele time after receiving the transcript, any party can designate
certain pages/exhibits as Confidential Information, subject to the same procedure herein for
designation of Confidential Information. The failure to serve a timely Notice of Designation
shall waive any designation of testimony taken in that deposition as Confidential Information,
unless otherwise ordered by the Court.
5.
Protection of Confidential Material.
(a)
General Protections.
Confidential Information shall not be used or
disclosed by the parties, counsel for the parties or any other persons identified in subparagraph
3
v
(b) for any purpose whatsoever other than in this litigation, including any appeal. Confidential
Information may not be used for any commercial purpose (aside from prosecuting or defending
against the claims in this action) or for the purpose of obtaining clients or developing business.
This Order does not restrict a party's use of its own Confidential Information.
(b)
Limited Disclosures. The parties and counsel for the parties shall not
disclose or permit the disclosure of any Confidential Information to any third person or entity
Subject to these requirements, the following
except as set forth in subparagraphs (1)-(9).
categories of persons may be allowed to review Confidential Information:
(1)
Counsel. Counsel for the parties and employees of counsel who
have responsibility for the action;
(2)
Employees of a Party. Individual employees of a party to the
extent counsel for the receiving party determines in good faith that
the employee's assistance is reasonably necessary to the conduct of
the litigation in which the information is disclosed;
(3)
The Court and its personnel;
(4)
Court Reporters and Recorders. Court reporters and recorders
engaged for depositions;
(5)
Contractors. Those persons specifically engaged for the limited
purpose of making copies of documents or organizing or
processing documents, including outside vendors hired to process
electronically stored documents;
(6)
Consultants and Experts. Consultants, investigators, or experts
employed by the parties or counsel for the parties to assist in the
preparation and trial of this action but only after such persons have
completed the certification contained in Attachment A,
Acknowledgment of Understanding and Agreement to Be Bound;
(7)
Witnesses at depositions. During their depositions, witnesses in
this action to whom disclosure is reasonably necessary. Witnesses
shall not retain a copy of documents containing Confidential
Information, except witnesses may receive a copy of all exhibits
marked at· their depositions in connection with review of the
transcripts. Pages of transcribed deposition testimony or exhibits to
depositions that are designated as Confidential Information
4
pursuant to the process set out in this Order must be separately
bound by the court reporter and may not be disclosed to anyone
except as permitted under this Order.
(8)
(9)
(c)
Author or recipient. The author or recipient of the document (not
including a person who received the document in the course of
litigation); and
Others by Consent. Other persons only by written consent of the
producing party or upon order of the Court and on such conditions
as may be agreed or ordered.
Control of Documents. Counsel for the parties shall make reasonable
efforts to prevent unauthorized or inadvertent disclosure of Confidential Information. Counsel
shall maintain the originals of the forms signed by persons acknowledging their obligations
under this Order for a period of three years after the termination of the case.
6.
Inadvertent Failure to Designate.
An inadvertent failure to designate a
document as Confidential Information does not, standing alone, waive the right to so designate
the document; but a failure to serve a timely Notice of Designation of deposition testimony as
required by this Order, even if inadvertent, waives any protection for deposition testimony. If a
party designates a document as Confidential Information after it was initially produced, the
receiving party, on notification of the designation, must make a reasonable effort to assure that
the document is treated in accordance with the provisions of this Order. No party shall be found
to have violated this Order for failing to maintain the confidentiality of material during a time
when that material has not been designated Confidential Information, even where the failure to
I~:kA- ,../,
so designate was inadvertent and where the material is s.ubS@Ej:ttSHt!-1 designated Confidential
Information.
7.
Filing of Confidential Information. This Order does not, by itself, authorize the
filing of any document under seal.
Any party wishing to file a document designated as
5
Confidential Information in connection with a motion, brief or other submission to the Court
must seek Court approval for the sealed filing.
8.
No Greater Protection of Specific Documents. Except on privilege grounds not
addressed by this Order, no party may withhold information from discovery on the ground that it
requires protection greater than that afforded by this Order unless the party moves for an order
providing such special protection.
9.
Challenges by a Party to Designation as Confidential Information.
The
designation of any material or document as Confidential Information is subject to challenge by
any party. The following procedure shall apply to any such challenge.
(a)
Meet and Confer. A party challenging the designation of Confidential
Information must do so in good faith and must begin the process by conferring directly with
counsel for the designating party. In conferring, the challenging party must explain the basis for
its belief that the confidentiality designation was not proper and must give the designating party
an opportunity to review the designated material, to reconsider the designation, and, if no change
in designation is offered, to explain the basis for the designation. The designating party must
respond to the challenge within five (5) business days.
this procedure. The burden of persuasion in any
Sttet challenge proceeding shall be on the
designating party. Until the Court rules on the challenge, all parties shall continue to treat the
materials as Confidential Information under the terms of this Order.
6
10.
Action by the Court. Applications to the Court for an order relating to materials
or documents designated Confidential Information shall be by motion. Nothing in this Order or
any action or agreement of a party under this Order limits the Court' s power to make orders
concerning the disclosure of documents produced in discovery or at trial.
11.
Use of Confidential Documents or Information at Trial. Nothing in this Order
shall be construed to affect the use of any document, material, or information at any trial or
hearing. A party that intends to present or that anticipates that another party may present
Confidential Information at a hearing or trial shall bring that issue to the Court's and parties'
attention by motion or in a pretrial memorandum without disclosing the Confidential
Information. The Court may thereafter make such orders as are necessary to govern the use of
such documents or information at trial.
12.
Confidential Information Subpoenaed or Ordered Produced in Other
Litigation.
(a)
If a receiving party is served with a subpoena or an order issued in other
litigation that would compel disclosure of any material or document designated in this action as
Confidential Information, the receiving party must notify the designating party, in writing,
immediately and in no event more than three court days after receiving the subpoena or order.
Such notification must include a copy of the subpoena or court order.
(b)
The receiving party also must immediately inform in writing the party
who caused the subpoena or order to issue in the other litigation that some or all of the material
covered by the subpoena or order is the subject of this Order. In addition, the receiving party
must deliver a copy of this Order promptly to the party in the other action that caused the
subpoena to issue.
7
The purpose of imposing these duties is to alert the interested persons to
(c)
the existence of this Order and to afford the designating party in this case an opportunity to try to
protect its Confidential Information in the court from which the subpoena or order issued. The
designating party shall bear the burden and the expense of seeking protection in that court of its
Confidential Information, and nothing in these provisions should be construed as authorizing or
encouraging a receiving party in this action to disobey a lawful directive from another court.
The obligations set forth in this paragraph remain in effect while the party has in its possession,
custody or control Confidential Information produced by the other party to this case.
13.
Obligations on Conclusion of Litigation.
(a)
Order Continues in Force.
fn
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Unless otherwise agreed or ordered, this
y~o..f"
Order shall remain in force1\ after dismissal or entry of final judgment not subject to further
appeal. "
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(b)
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UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JONESBORO DIVISION
DELORIS SUMPTER, ET AL.,
Plaintiff,
)
)
)
)
v.
)
Case No. 3:14-cv-00229-DPM
)
CRITTENDEN HOSPITAL ASSOCIATION,
GENE CASHMAN, DAVID RAINES, BRAD
MCCORMICK, CIGNA HEALTH AND LIFE
INSURANCE CO. AND CIGNA CORPORATION,
Defendants.
RHONDA MICHELLE GOODFELLOW,
on behalf of herself and all similarly situated
persons,
Plaintiffs,
v.
) Removed from the Circuit Court
) of Crittenden County, Arkansas,
) No. CV-2014-303
)
)
)
)
)
)
)
)
)
)
EUGENE K. CASHMAN, JR.; JAMIE R.
CARTER, JR.; DAVID G. BAYTOS;
DAVID RAINES, JR.; W. BRAD
MCCORMICK; JASON W. COLLARD;
HERSCHEL F. OWENS; ANDREW
LUTTRELL; DONNA B. LANIER;
CAROL C. MCCORMACK; KEITH M.
INGRAM; RANDALL CATT; DAVID
FORD; THOMAS F. DONALDSON, JR.;
WILLIAM JOHNSON; LANNIE L.
LANCASTER; JULIO P. RUIZ; SHERRY
L. LONDON; NESS S. SECHREST;
RANDY R. SULLIVAN; LEVEN
WILLIAMS; SIMPLIFI HEALTH
BENEFIT MANAGEMENT, LLC; and
CIGNA HEALTH AND LIFE
INSURANCE COMPANY,
Defendants.
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Case No. 3:14-cv-00226-DPM
AGREED QUALIFIED HIPAA-PROTECTIVE ORDER
The parties have agreed to the terms of this Order, and the Court finds it appropriate and
in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA")
(Pub.L. 104-191, 110 Stat. 1936). Therefore, the Court orders as follows:
1.
HIPAA. The parties desire to ensure the privacy of medical information, medical
records, demographic information, and financial information relating to participants and
beneficiaries (collectively, "members") of the health benefits plan ("the Plan") established by the
Crittenden Hospital Association ("CHA"). The Plan is governed by the Employee Retirement
Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Patient Health Information,
as defined below, will be designated, in the producing party's discretion, as "Confidential PHI"
under this Order.
(a)
Patient Health Information. Patient Health Information includes "health
information," "individually identifiable health information," and "protected health information,"
as those phrases are defined in HIPAA, 45 C.F.R. § 160.103.
Patient Health Information
includes, but is not limited to:
1.
information that: 1) identifies or reasonably could be expected to identify
an individual; and 2) relates to a) the past, present, or future physical or
mental health or condition of an individual; b) the provision of health care
to an individual; or c) the past, present, or future payment for the provision
of health care to an individual.
n.
medical bills, claims forms, data on claims submitted by health facilities
and professionals, charge sheets, medical records, medical charts, test
results, notes, dictation, invoices, itemized billing statements, remittance
advice forms, explanation of benefits, checks, notices, and requests, and
all notes, summaries, compilations, extracts, abstracts or oral
communications that are based on or derived from Patient Health
Information.
111.
the information referred to in 45 C.F.R. § 164.514(b), including, but not
limited to: name; address; names of relatives; name of employers; all
2
elements of dates; telephone numbers; fax numbers; electronic mail
addresses; social security numbers; medical record numbers; health plan
beneficiary numbers; account numbers; certificate/license numbers;
Internet Protocol (IP) address numbers; biometric identifiers; full face
photographic images; or any other unique identifying numbers,
characteristic, or code of any patient.
(b)
Authorization for Covered Entities to Disclose Protected Health
Information. Pursuant to 45 C.F.R. § 164.512(e)(1)(i), the Court authorizes each party and its,
his, or her counsel to release to the other parties and their counsel Patient Health Information
relating to members of the Plan. Counsel of record for the parties, and any "covered entities," as
that term is defined in 45 C.F.R. §160.103, are hereby authorized to receive, subpoena, disclose,
and transmit such Patient Health Information as long as it is designated "Confidential PHI"
subject to this Order.
(c)
HIPAA-Qualified Protective Order. The parties are prohibited from
using Patient Health Information under this Order for any purpose other than this litigation and
will be required to return any such information at the end of the litigation, upon request of the
producing party. All Patient Health Information produced in this action shall remain subject to
the terms of this ~rder after the termination of the litigation, absent contrary c9rder by the Court.
/
/
2.
/
/
Protection of Confidential Material.
(a)
General Protections. Patient Health Information shall not be used or
disclosed by the parties, counsel for the parties or any other persons identified in subparagraph
(b) for any purpose whatsoever other than in this litigation, including any appeal. Patient Health
Information may not be used for any commercial purpose (aside from prosecuting or defending
against the claims in this action) or for the purpose of obtaining clients or developing business.
This Order does not restrict a party' s use of its own Patient Health Information.
3
V
(b)
Limited Disclosures. The parties and counsel for the parties shall not
disclose or permit the disclosure of any Patient Health Information to any third person or entity
except as set forth in subparagraphs (1)-(9).
Subject to these requirements, the following
categories of persons may be allowed to review Patient Health Information:
(1)
Counsel. Counsel for the parties and employees of counsel who
have responsibility for the action;
(2)
Employees of a Party. Individual employees of a party to the
extent counsel for the receiving party determines in good faith that
the employee' s assistance is reasonably necessary to the conduct of
the litigation in which the information is disclosed;
(3)
Plaintiffs. An individual plaintiff may review Patient Health
Information relating to that individual plaintiff; counsel for
plaintiffs may not disclose to an individual plaintiff Protected
Health Information that relates to other persons;
(4)
The Court and its personnel;
(5)
Court Reporters and Recorders. Court reporters and recorders
engaged for depositions;
(6)
Contractors. Those persons specifically engaged for the limited
purpose of making copies of documents or organizing or
processing documents, including outside vendors hired to process
electronically stored documents;
(7)
Consultants and Experts. Consultants, investigators, or experts
employed by the parties or counsel for the parties to assist in the
preparation and trial of this action but only after such persons have
completed the certification contained in Attachment A,
Acknowledgment of Understanding and Agreement to Be Bound;
(8)
Witnesses at depositions. During their depositions, witnesses in
this action to whom disclosure is reasonably necessary. Witnesses
shall not retain a copy of documents containing Patient Health
Information, except witnesses may receive a copy of all exhibits
marked at their depositions in connection with review of the
transcripts. Pages of transcribed deposition testimony or exhibits
to depositions that are designated as Patient Health Information
pursuant to the process set out in this Order must be separately
bound by the court reporter and may not be disclosed to anyone
except as permitted under this Order.
' 4
(9)
(10)
(c)
Author or recipient. The author or recipient of the document (not
including a person who received the document in the course of
litigation); and
Others by Consent. Other persons only by written consent of the
producing party or upon order of the Court and on such conditions
as may be agreed or ordered.
Control of Documents. Counsel for the parties shall make reasonable
efforts to prevent unauthorized or inadvertent disclosure of Patient Health Information. Counsel
shall maintain the originals of the forms signed by persons acknowledging their obligations
under this Order for a period of three years after the termination of the case.
3.
Obligations on Conclusion of Litigation.
(a)
Order Continues in Force.
Unless otherwise agreed or ordered, this
Order shall remain in force after dismissal or entry of final judgment not subject to further
appeal.
(b)
Obligations at Conclusion of Litigation. Within 60 days after dismissal
or entry of final judgment not subject to further appeal, all Patient Health Information and
documents marked "Confidential PHI" under this Order, including copies, electronic images,
duplicates, extracts, summaries or descriptions that contain the Patient Health Information, shall
be returned to the producing party unless: (1) the document has been offered into evidence or
filed without restriction as to disclosure; (2) the parties agree to destruction to the extent
1
practicable in lieu of return; or (3) as to documents bearing the notations, summations, or other
mental impressions of the receiving party, that party elects to destroy the documents and certifies
to the producing party that it has done so.
1
Th e parties may choose to agree that the receiving party shall destroy documents containing Patient Health
Information and certify the fact of destruction, and that the receiving party shall not be required to locate, isolate and
return e-mails (including attachments to e-mails) that may include Patient Health Information, or Patient Health
Information contained in deposition transcripts or drafts or final expert reports.
5
(c)
Retention of Work Product and one set of Filed Documents.
Notwithstanding the above requirements to return or destroy documents, counsel may retain (1)
attorney work product, including an index that refers or relates to designated Patient Health
Information so long as that work product does not duplicate verbatim substantial portions of
Patient Health Information, and (2) one complete set of all documents filed with the Court
including those filed under seal. Any retained Patient Health Information shall continue to be
protected under this Order.
An attorney may use his or her work product in subsequent
litigation, provided that its use does not disclose or use Patient Health Information.
4.
Order Subject to Modification. This Order shall be subject to modification by
the Court on its own initiative or on motion of a party or any other person with standing
concerning the subject matter.
5.
Persons Bound. This Order shall take effect when entered and shall be binding
upon all counsel of record and their law firms, the parties, and persons made subject to this Order
by its terms.
So Ordered.
Dated:
Hon. D.P. Marshall Jr.
United States District Judge
6
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JONESBORO DIVISION
DELORIS SUMPTER, ET AL.,
Plaintiff,
)
)
)
)
)
v.
Case No. 3:14-cv-00229-DPM
)
CRITTENDEN HOSPITAL ASSOCIATION,
GENE CASHMAN, DAVID RAINES, BRAD
MCCORMICK, CIGNA HEALTH AND LIFE
INSURANCE CO. AND CIGNA CORPORATION,
Defendants.
RHONDA MICHELLE GOODFELLOW,
on behalf of herself and all similarly situated
persons,
Plaintiffs,
) Removed from the Circuit Court
) of Crittenden County, Arkansas,
) No. CV-2014-303
)
)
)
)
)
)
)
)
)
)
v.
EUGENE K. CASHMAN, JR.; JAMIE R.
CARTER, JR.; DAVID G. BAYTOS;
DAVID RAINES, JR.; W. BRAD
MCCORMICK; JASON W. COLLARD;
HERSCHEL F. OWENS; ANDREW
LUTTRELL; DONNA B. LANIER;
CAROL C. MCCORMACK; KEITH M.
INGRAM; RANDALL CATT; DAVID
FORD; THOMAS F. DONALDSON, JR.;
WILLIAM JOHNSON; LANNIE L.
LANCASTER; JULIO P. RUIZ; SHERRY
L. LONDON; NESS S. SECHREST;
RANDY R. SULLIVAN; LEVEN
WILLIAMS; SIMPLIFI HEALTH
BENEFIT MANAGEMENT, LLC; and
CIGNA HEALTH AND LIFE
INSURANCE COMPANY,
Defendants.
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Case No. 3:14-cv-00226-DPM
ATTACHMENT A-- ACKNOWLEDGMENT
AND
AGREEMENT TO BE BOUND
The undersigned hereby acknowledges that he/she has read the Agreed Qualified HIP AA
Protective Order dated _ _ _ __ _ _ __ _ _ _ _ in the above-captioned action and
attached hereto, understands the terms thereof, and agrees to be bound by its terms.
The
undersigned submits to the jurisdiction of the Eastern District of Arkansas in matters relating to
the Order and understands that the terms of the Order obligate him/her to use materials
designated as Confidential PHI in accordance with the Order solely for the purposes of the
above-captioned action, and not to disclose any such Confidential PHI to any other person, firm
or concern.
The undersigned acknowledges that violation of the Order may result in penalties for
contempt of court.
Name:
Job Title:
Employer:
Business Address:
Date: - - - - - - - -
Signature
2
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