I understand that if my records contain documentation of alcohol abuse, psychiatric condition, drug abuse or communicable diseases this information will be released as part of my record. I understand that if the person or entity receiving this information is not covered by federal privacy regulations this information will no longer be protected and may be re-disclosed. I understand that I may revoke this authorization at any time, but revocation will not apply to information that has already been released. Revocations should be sent to the address noted at the top of this form. I understand that a copy or fax of this document is just as valid as the original document. I understand that this authorization is valid for six (6) months unless revoked in writing for an earlier date. I understand that there will be a charge for obtaining the requested information unless records are directly sent to another healthcare provider.