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This authorization is valid until I revoke it or 60 days after I have completed treatment, whichever is sooner. This authorization includes information placed in my record after the date of my signature and before the expiration of my consent.Signature of ALF Resident. Purpose and Laws: This form, when properly completed, permits the release of confidential information about a person receiving services. Signing this authorization, i am allowing the release of any and all of my information and records which i am authorized to receive as specified on this. Completion of this form authorizes the release of information described in the section. Instructions for completing the Authorization for the Release of Confidential Information. 1. To protect our patient's confidential medical information, we must have a valid, complete, and legible authorization to disclose their health information. 1. All sections of this authorization form MUST be completed to be considered valid. Name – Person Whose Records Will be Released (Record. Subject). Address.