AUTHORIZATION FOR THE USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION (HIPAA)
As required by the Health Insurance Portability and Accountability Act of 1996, Storm Clinic Prof. LLC DBA Allure Health, may not use or disclose our health information without your authorization except as provided in our Notice of Privacy Practices. Your signature on this form indicates that you are giving permission for the uses and disclosures described herein. You may revoke this authorization at any time by signing and dating the revocation section on your copy of this form and returning it to this office.