USES AND DISCLOSURES
We will not make any other
uses or disclosures of your health information unless you sign
a written Authorization to Disclose Medical Information form.
The content of this authorization is determined by federal law.
We may initiate the authorization process if we refer you to another
health care provider or if we need records from a provider you
have seen before (e.g., Pap or lab results).
You may initiate
the process if you want us to send your information to someone; use a properly
completed authorization form from your provider's office or use one of ours.
- Download Authorization for Disclosure of Medical Records Form (PDF)
If we initiate the process
and ask you to sign an authorization form, you do not have to
sign it. If you do not sign the authorization, we cannot make
the disclosure.
If you do sign an authorization form, you may revoke it at any time
unless we have already acted in reliance upon it. Revocations
must be in writing and sent to our office.
