Confidentiality Agreement Form 35


Form 35
This CONFIDENTIALITY AGREEMENT (“Agreement”) is entered into by
and between (“Health Professional”), and ____________________________________
(“Custodian”). Health Professional and Custodian may also be referred to individually
as “Party” or collectively as “Parties.”
Capitalized terms used herein and not defined
shall have the meaning ascribed to them in the Rules of Practice and Procedure before
the Colorado Oil and Gas Conservation Commission (“COGCC” and “COGCC Rules”).
As permitted under the COGCC Rules, Custodian claims that the specific
identity of a chemical, the concentration of a chemical or both the specific identity and
the concentration of a chemical is/are claimed to a Trade Secret.
In accordance with the COGCC Rules:
Health Professional has requested in writing and provided to Custodian a
written statement of need (as described in the COGCC Rules) for the specific
identity of chemicals and the concentration thereof used in the Custodian’s
operations (“Trade Secret Information”); or
Upon determination that a medical emergency exists and the Trade Secret
Information is necessary for emergency medical treatment, the Custodian
disclosed Trade Secret Information to Health Professional upon a verbal
acknowledgement by Health Professional that such information will not be used
for purposes other than the health needs asserted, and that the Health
Professional shall otherwise maintain the information as confidential. Custodian
may request a written statement of need, and a confidentiality agreement as
soon as circumstances permit from all Health Professionals to whom Trade
Secret Information was disclosed in an emergency situation.
Identification of Trade Secret Information. Any Trade Secret Information
provided to Health Professional by Custodian in tangible form that is intended to be
Trade Secret Information shall be labeled “CONFIDENTIAL” or “TRADE SECRET” or
“PROPRIETARY” or bear a similar written legend.
Any Trade Secret Information
provided to Health Professional by Custodian orally or visually that is intended to be
Trade Secret Information shall be identified as confidential, trade secret or proprietary
by verbal notice at the time such information is provided.
Nondisclosure of Trade Secret Information. Health Professional agrees to
hold confidential all Trade Secret Information provided by the Custodian and not to
make use of it for purposes other than medical diagnosis, treatment, or other health
needs asserted in the statement of need.
Nothing in this Agreement shall prohibit Health Professional from
disclosing Trade Secret Information obtained from Custodian if Health Professional can
document that: a) the information was not identified as Trade Secret Information as
provided in paragraph 4 of this Agreement; or b) Health Professional is required by law
to disclose such information pursuant to a court order or government agency order.
Notice. If Health Professional receives notice that it may become legally
required to disclose any Trade Secret Information, Health Professional shall provide
Custodian with prompt notice of any proceedings reasonably calculated to require such
disclosure. Custodian may, if it desires and at its own expense, intervene or seek a
protective order preventing the disclosure of such Trade Secret Information. In the
event disclosure is required by court order of government agency order, Health
Professional shall disclose only that portion of the Trade Secret Information which
Health Professional is advised by Health Professional’s counsel is legally required to be
Entire Agreement.
The Parties acknowledge and agree that this
Agreement embraces the entire Agreement between the Parties relating to the subject
matter hereof.
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(Form 35, as of 03/05/2012)


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