Warning: This disclosed information shall be kept confidential to the best of the provider’s ability; however, in the event that the information is re-disclosed, the information is no longer protected by law. I understand that my records may contain information regarding mental health diagnosis and treatment, drug and/or alcohol abuse (Per 42CFR, Part 2), the testing, diagnosis, or treatment of HIV/AIDS and/or sexually transmitted diseases (Per RCW 70.24.105 I give my specific authorization for these protected records to be released. I understand that I may revoke this authority at any time, except to the extent that action has already been taken. To revoke this authorization, it must be in writing and submitted to Julie Holt, MA LMHC. I understand that Julie Holt, MA LMHC is prohibited from conditioning treatment, payment, or eligibility for services on my agreement to sign this authorization. Unless otherwise noted in my mental health record, this authorization will remain in effect until treatment ends.