I understand that this information may be protected by Title 42 (Code of Federal Rules of Privacy of Individually Identifiable Health Information, Parts 160 and 164) and Title 45 (Federal Rules of Confidentiality of Alcohol and Drug Abuse Patient Records, Chapter 1, Part 2), plus applicable state laws. I further understand the information disclosed to the recipient may not be protected under these guidelines if they are not a health care provider covered by state or federal rules. I understand that I may refuse to give my permission to share this information. I understand I have a right to receive a copy of this authorization. I understand this authorization is voluntary, and I may revoke this consent at any time by providing written notice, and after one year, this consent automatically expires.