I hereby consent and authorize to use and disclose my health information, which includes all or any part of my Medical Records. I
Understand that, for example, my health information may be used or disclosed to provide for my care and treatment, communicate
among various health care professionals who are involved in my care or treatment, to bill or obtain payment for care, and conduct its
business and health care operation. In addition, I Understand they may release my protected health information as required by law
or court order.