Notice to Recipient: This information has been disclosed to you from records whose confidentiality is protected by Federal Law. If the information to be released pertains to the diagnosis and treatment of mental health, alcoholism, and or substance addiction/abuse, I understand that the confidentiality of the information is protected by Federal Law. Federal regulations (42 C.F.R. Part 2) prohibit you from making any 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.