I understand that by choosing "Full Medical Record", records that are released or obtained my include up to, but not limited to, psychological, psychiatric, or other mental impairments or treatment, including psychotherapy notes, dug abuse, alcoholism , or other substance abuse, records with may indicate the presence of communicable or noncommunicable diseases, and/or tests for, or record of, HIV/AIDS, and gene-related impairments, including genetic testing results. I understand that the clinic will not condition treatment on my signing this authorization. The clinic will not deny me treatment if I do not wish to sign this form. I may refuse to sign this authorization form. I understand that I may revoke this authorization at any time, unless the disclosing party has already relied on my authorization to disclose health information. To revoke my authorization, I must submit a written request to Dr. Philip Malinas & Associates. Unless I revoke this authorization earlier, it will expire one year from the date of signature. I understand that if this information is disclosed to a third party, the information may no longer be protected by the federal privacy regulations and may be re-disclosed by the person/organization that receives the information. I understand the matters discussed on this form. I release the provider, its employees, officers, and directors, medical staff members and business associated from any legal responsibility or liability for the disclosure of the above information to the extent indicated and authorized herein.