I understand that my mental health and/or alcohol drug treatment records are protected under the federal regulations governing Confidentiality of Alcohol/Drug Abuse Patient Records, 42 C.F.R., Part 2, and the Health lnsurance Portability and Accountability Act (HIPAA) of 1996, 45 C.F.R. Pts. 160 & 164, and cannot be disclosed without my written consent unless otherwise provided for in the regulations. This Disclosure Authorization is specifically intended to include any references to diagnosis, testing, and/or treatments for communicable diseases, including sexually transmitted, mental health services and alcohol drug services. I also understand that I may revoke this consent in writing at any time except to the extent that action has been taken in reliance on it, including provision of healthcare services requiring subsequent disclosure to effect payment. Unauthorized re-disclosure by recipient is prohibited, but may be a potential risk. I understand that I do not have to sign this authorizatisn in order to receive health care benefits, except for healthcare services necessary to create an assessment or report for disclosure to the recipient identified in this authorization, ln any event, this authorization expires automatically as follows: 1 year from patient's authorization and signature or immediately after the patient's revocation of authorization.