This authorization shall be in force and effect until one year after this request has been signed.
I understand that I have the right to revoke this authorization, in writing, at any time by sending such written notification to Intrepid Research, LLC.
I understand that information released pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer be protected by federal or state law.
Intrepid Research, LLC will not condition my treatment, payment, enrollment in a health plan or eligibility for benefits (if applicable) on whether I provide authorization for the requested disclosure.
I understand that I have the right to: Inspect or copy the protected health information to be disclosed as permitted under federal law.