I hereby authorize Nuance Communications to share the health images and other health information updated to my Nuance PowerShare account, to only those entities and individuals I designate, for the purpose of providing me with medical care and for the purpose of sharing my images and information with others that I select.
I understand and agree this authorization permits the disclosure of health related information about me, to the entities and individuals I so designate, and may also contain sensitive information relating to the following:
I understand and agree that this authorization also covers any record that was created by a doctor or other health care provider other than the doctor or health care provider who supplied the record to Nuance PowerShare.
This authorization will remain in effect and permit the ongoing disclosure by Nuance of information in the PowerShare system until I delete my account entirely or revoke this authorization. I may revoke this authorization at any time by using the features or options described in PowerShare online help system. I understand that my revocation will not apply to actions already taken in reliance on my prior authorization.
I understand that I may request a copy of this authorization at any time.