Description of PHI to be Used or Disclosed. This authorization is to allow the above-identified Coach(es) to receive any and all PHI necessary or desirable to direct and obtain appropriate medical care and make related decisions with respect to the above-referenced Basketball Player. This authorization applies to the following PHI. (Specifically describe the information to be used or disclosed, including, but not limited to, meaningful descriptors such as date(s) and type(s) of information provided, level of detail to be released, origin of information, etc.)
Purpose for PHI. This PHI is being used or disclosed for the following purposes:
To allow for the provision of medical treatment and services to the Basketball Player in the event such treatment and services are needed and the Basketball Player’s parents or guardians are not physically present at the time such treatment and services are provided.
Expiration of This Authorization. This authorization shall remain in force and effect until the following specified date or event that is related to the individual or the purpose of the use or disclosure of PHI, at which time this authorization to use or disclose this PHI expires. The Basketball Player's graduation from high school or termination of membership in Colorado Basketball Club, whichever first occurs.