I understand that having the right to inspect and copy any written information disclosed and the right to revoke this consent at any time by giving written notice to BROWNSTONE PSYCHIATRY.
I UNDERSTAND THAT REQUESTED COPIES WILL BE SUBJECT TO A REASONABLE FEE AS PROVIDED BY STATE LAW. ALL FEES WILL BE ON A PRE-PAY BASIS.
I understand that I may not withdraw authorization for a disclosure that is necessary for the purpose of making payment to the facility for services provided. I understand that federal law and regulations protect the confidentiality of alcohol a drug abuse patient records maintained by BROWNSTONE PSYCHIATRY. Generally, we may not say to a person outside the facility that a patient is in treatment or disclose any information identifying a patient as an alcohol or drug abuse unless:
The patient consents in writing by signing an authorization for the disclosure of information
The disclosure is allowed by court order
The disclosure is made to medical personnel in a medical emergency or to a qualified personnel for research, audit or
Program evaluation. (42 CFR, chapter 1 part 2)