I understand that the information released is for specific purpose stated above. Any other use of this information without written consent of the patient
I understand that I have the right to revoke this authorization at any time. I understand that if I revoke this authorization, I must do SO in writing and present my written revocation to Woodlands Arthritis Clinic PA. I understand that this revocation will not apply to information already released in response to this authorization. I understand that the revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy. Unless otherwise revoked, this authorization expires in one year, I understand that authorizing the disclosure of this health information is voluntary.