Consent to Release Information Sample Clauses
Consent to Release Information. Upon request by XXXXX, PROVIDER shall provide XXXXX with authorizations, consents or releases, in connection with any inquiry by XXXXX of any hospital, educational institution, governmental or private agency or association (including without limitation the National Practitioner Data Bank) or any other entity or individual relative to PROVIDER’s professional qualifications, PROVIDER’s mental or physical fitness, or the quality of care rendered by PROVIDER.
Consent to Release Information. We may from time to time give any credit or other information about you to, or receive such information from, (a) any financial institution, credit reporting agency, rating agency or credit bureau, (b) any person, firm or corporation with whom you may have or propose to have financial dealings, and (c) any person, firm or corporation in connection with any dealings you have or propose to have with us. You agree that we may use that information to establish and maintain your relationship with us and to offer any services as permitted by law, including services and products offered by our subsidiaries when it is considered that this may be suitable to you.
Consent to Release Information. All communications with a treating psychologist and all records relating to the provision of psychological services are confidential. Because of this, I will ask you to provide written consent before speaking to, or communicating in writing with, anyone about your care.
Consent to Release Information. I acknowledge that Seton Family of Doctors may release my protected health information as necessary for treatment, payment and health care operations and acknowledge that Seton’s Notice of Privacy Practice provides information on how my protected health information may be used and/or disclosed for these purposes. I understand that protected health information pertains to my diagnosis and/or treatment, and includes, but is not limited to, information related to my health history, diagnosis, treatment, prognosis, mental illness (excluding psychotherapy notes), use of alcohol or drugs, prescriptions and laboratory test results, including HIV or the diagnosis of AIDS. I understand that use or disclosure of my protected health information may be necessary before my insurer will pay for the cost of my medical treatment and that if I refuse to consent to this disclosure I may be required to pay the entire cost of medical care provided by Seton Family of Doctors. I acknowledge and consent to allow Seton Family of Doctors to use health information exchange systems to electronically transmit, receive and/or access my medical information, which may include, but is not limited to, treatments, prescriptions, labs, medical and prescription history and other protected health information. I may “opt out” and not have my protected health information disclosed through health information exchange systems by providing the signed Seton “opt-out” form to the practice location where I receive treatment.
Consent to Release Information. I acknowledge that Austin Dermatologic Surgery Center may release my protected health information as necessary for treatment, payment and health care operations and acknowledge that Seton’s Notice of Privacy Practice provides information on how my protected health information may be used and/or disclosed for these purposes. I understand that protected health information pertains to my diagnosis and/or treatment, and includes, but is not limited to, information related to my health history, diagnosis, treatment, prognosis, mental illness (excluding psychotherapy notes), use of alcohol or drugs, prescriptions and laboratory test results, including HIV or the diagnosis of AIDS. I understand that use or disclosure of my protected health information may be necessary before my insurer will pay for the cost of my medical treatment and that if I refuse to consent to this disclosure I may be required to pay the entire cost of medical care provided by Austin Dermatologic Surgery Center. I acknowledge and consent to allow Austin Dermatologic Surgery Center to use health information exchange systems to electronically transmit, receive and/or access my medical information, which may include, but is not limited to, treatments, prescriptions, labs, medical and prescription history and other protected health information. I may “opt out” and not have my protected health information disclosed through health information exchange systems by providing the signed Seton “opt-out” form to the practice location where I receive treatment.
Consent to Release Information. I acknowledge that University of Texas Physicians may release my protected health information as necessary for treatment, payment and health care operations and acknowledge that Seton’s Notice of Privacy Practice provides information on how my protected health information may be used and/or disclosed for these purposes. I understand that protected health information pertains to my diagnosis and/or treatment, and includes, but is not limited to, information related to my health history, diagnosis, treatment, prognosis, mental illness (excluding psychotherapy notes), use of alcohol or drugs, prescriptions and laboratory test results, including HIV or the diagnosis of AIDS. I understand that use or disclosure of my protected health information may be necessary before my insurer will pay for the cost of my medical treatment and that if I refuse to consent to this disclosure I may be required to pay the entire cost of medical care provided by the University of Texas Physicians. I acknowledge and consent to allow University of Texas Physicians to use health information exchange systems to electronically transmit, receive and/or access my medical information, which may include, but is not limited to, treatments, prescriptions, labs, medical and prescription history and other protected health information. I may “opt out” and not have my protected health information disclosed through health information exchange systems by providing the signed Seton “opt-out” form to the practice location where I receive treatment.
Consent to Release Information. Patient expressly agrees that Newport-Mesa Audiology may:
a. Xxxx Patient’s insurance carrier for any and all services rendered, if applicable;
b. Obtain any and all information from Patient’s insurance carrier regarding such billing including, without limitation, whether Facility’s xxxx has been accepted, whether payment has been made directly to the Patient, when payment occurred and the amount paid; and,
c. Release any and all information as requested by Patient’s insurance carrier in accordance with billing practices and procedures.
Consent to Release Information. We will need to talk to your Broker and others involved in the sale. By signing this Agreement, you are authorizing us to communicate and share personal financial information about your Property, marketing strategy, offers received, the Loan, credit history, other liens, and plans for relocation with your Broker and other third parties that could be involved in the sale of your Property, including employees of the United States Treasury and its financial agents, Xxxxxx Xxx and Freddie Mac.
Consent to Release Information. The Parties will not disclose Confidential Information, including but not limited to information regarding the terms of this Agreement ,to any other entities unless agreed to in writing, except as necessary for retrocession, as necessary for prudent risk management purposes, as requested by external auditors, as required by court order, or as allowed by law or regulation.
Consent to Release Information. CIBC may from time to time give any credit or other information about the Borrower to, or receive such information from, (i) any financial institution, credit reporting agency, rating agency or credit bureau, (ii) any person, firm or corporation with whom the Borrower may have or proposes to have financial dealings, and (iii) any person, firm or corporation (including any guarantor, if applicable) in connection with any dealings the Borrower has or proposes to have with CIBC, and CIBC may obtain such information from them. The Borrower agrees that CIBC may use that information to establish and maintain the Borrower’s relationship with CIBC and to offer any services as permitted by law, including services and products offered by CIBC’s Subsidiaries when it is considered that this may be suitable to the Borrower.