Valdosta State University

Statement Accompanying Disclosures

As the recipient of this information, you are prohibited from using this information for any purpose other than the stated purpose. You may disclose this information to another party ONLY:

• With written authorization from the patient or his or her legal representative;
• As required by state law; or
• If urgently needed for the patient's continued care.

You must destroy this information after its stated need has been fulfilled.

If this disclosure contains information relating to alcohol or drug abuse education, training, treatment, rehabilitation, or research, the following shall apply:

This information has been disclosed to you from records whose confidentiality is protected by federal law. Federal regulations (Title 42 CFR Part 2) prohibit you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is NOT sufficient for this purpose.