I understand that my authorization terminates one year from the date of my signature. I understand that I have the right to revoke this authorization in writing at any time prior to the termination date. I understand that Otik Health Care Services cannot release information disclosed by this authorization to anyone other than listed above and that informed used or disclosed pursuant to this authorization may be subject to redisclosure by the recipient only upon my written consent. I further understand that the information disclosed as a result of this authorization may no longer be protected and could be redisclosed by the recipient without my permission. Otik Health Care Services will not condition treatment on my signing this authorization. A copy of this authorization shall be considered as valid as the original.