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202005711
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Last modified
8/7/2020 9:49:30 AM
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8/7/2020 9:49:28 AM
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DEEDS
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202005711
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202O057If <br />C.F.R. § 164.502(g)(2)) for all purposes relating to my "protected health information." My Agent <br />is authorized to request and receive all "protected health information" and all other types of my <br />medical records and information from my doctors, hospitals, and any other medical facility or <br />provider. <br />ARTICLE IV <br />HEALTH CARE <br />My Agent is authorized in my Agent's sole and absolute discretion from time to time and at <br />any time to exercise the authority described below relating to matters involving my health and <br />medical care. <br />The Agent, as my "personal representative," shall have powers granted by all applicable <br />state and federal law, including the Health Insurance Portability and Accountability Act <br />("HIPAA"). The information disclosed by any such health care provider is subject to further <br />disclosure and may thereafter no longer be protected by such privacy rules. This authorization <br />shall remain in effect until the earlier of its revocation by me or my death. <br />(1) Power of Access and Disclosure of Medical Records and Other Personal <br />Information. To request, receive, and review any information, including both verbal or written, <br />regarding my personal affairs or my physical or medical health, including medical and hospital <br />records and any "protected health information" as defined by the Health Insurance Portability and <br />Accountability Act ("HIPAA"), and to execute any releases or other documents that may be <br />required to obtain such information, and to disclose or deny such information to such persons, <br />organizations, firms, or corporations as my Agent shall deem appropriate. The Agent shall have <br />powers granted by all applicable state and federal law, including HIPAA. For such purposes, I do <br />hereby designate my Agent as my "personal representative" with all the authority granted to such <br />person under HIPAA. The Agent may grant releases to hospital staff, physicians, and other health <br />care providers who act in reliance on instructions given by my Agent or who render written <br />opinions to the Agent from all liability for damages. This authorization is intended to provide my <br />health care providers with the authorization necessary to allow each of them to disclose such <br />general medical information and protected health information regarding me to the above <br />designated agents. The information disclosed by any such health care provider pursuant to this <br />authorization is subject to further disclosure and use by such designated agents and may thereafter <br />no longer be protected by such privacy rules. This authorization shall remain in effect until the <br />earlier of its revocation by me or my death. <br />(2) Psychiatric Records. My Agent is authorized to request, receive, and review any <br />information, including, both verbal or written, regarding my psychiatric or mental health, <br />including psychiatric records, psychiatric notes, and hospital records and any "protected health <br />information" as defined by the Health Insurance Portability and Accountability Act ("HIPAA"), <br />and to execute any releases or other documents that may be required to obtain such information, <br />and to disclose or deny such information to such persons, organizations, firms, or corporations as <br />my Agent shall deem appropriate. The Agent shall have powers granted by all applicable state and <br />federal law including HIPAA. For such purposes, I do hereby designate my Agent as my "personal <br />representative" with all the authorities granted to such person under HIPAA. The Agent may grant <br />releases to hospital staff, physicians, and other health care providers who act in reliance on <br />Durable Power of Attomey for Janice S. Nikodym Page 6 <br />
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