I understand that this information obtained will be treated in a confidential manner by NDHHS under the provisions of the Family Education Rights and Privacy Act (FERPA). FERPA prohibits disclosure of personally identifiable information without consent except in limited circumstances. Please note that if the request is for health or medical information, the medical information received by NDHHS is protected under FERPA privacy standards and not the Health Insurance Portability and Accountability Act (HIPAA
This authorization is effective for a period of no longer than twelve (12) months. I understand that my consent for the release of records is voluntary and can withdraw my consent at any time in writing. Should I withdraw my consent, it does not apply to information that has already been provided under the prior consent for release.