I understand that if I have any questions about my clinical records, or the content within, I can contact BH Therapy Group and someone will meet with me to discuss my records. I understand that my treatment records are protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR, Parts 160 & 164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I understand that authorization will expire in six (6) years if no other expiration date is noted, but that I may revoke this consent at anytime and that any notice to revoke consent must be in writing. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations. I understand that I may be charged up to $45 for administrative fees associated with release of records.