Employer Redisclosure Notice
Authorization of Disclosure of Personal Data
This Authorization will remain in effect until 2050, or until you revoke such authorization in writing, after which Videra will no longer be authorized to disclose your medical information until and unless you execute another Authorization.
You have the right to receive a copy of this authorization upon request. Should you wish to receive a copy of this authorization, please send a request to firstname.lastname@example.org.