The within information is disclosed to you from records whose confidentiality is protected by Federal law. Federal Regulations (42 CFR-Part 2 AND 45 CFR Parts 160 & 164) prohibit you from making further disclosure of it without the specific written consent of the person to whom it pertains or as otherwise permitted by such regulations. A General Authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse client.
THIS RELEASE FORM COMPORTS WITH REQUIRMENTS OF HIPAA PRIVACY RULE REGUALTIONS AT 45 CFR PARTS 160 & 164