Except to the extent that action has already been taken in reliance upon this authorization, I understand that I may revoke this authorization at any time by giving written notice to Southern Highlands CMHC. Unless revoked earlier, this authorization will expire 180 days from the date of signing.
I understand that protected health information released pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer be protected by HIPAA, except as prohibited by applicable state or federal laws and regulations. I understand that I may refuse to sign this authorization and that my refusal to sign will not affect my ability to obtain treatment, payment, enrollment or eligibility for benefits. Unless otherwise provided by law, I may inspect any information to be used or disclosed under this authorization.