202109300 - Laserfiche WebLink

Browse

202109300 disclosure of this intiirmation by third parties and that such further disclosure muy not he protected under HIPAA. In order to induce the disclosing party to disclose the aforesaid private andiur protected confidential information, 1 forever release and hold harmless said disclosing party who relies upon this instnuncnt from any liability under amlidentiality rules arising under HIP.A.A as a consequence of said diselo..cure. t authorize my went to execute any and all releases or other documents that may be necessary in order to +3ht in disclosure of my patient records and other medical information subject to and protected by HIPAA. Any person. including my agent, may rely upon his power of attorney or a copy of it unless that person knows it has terminated or is invalid. To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or facsimile of this power of attorney may act hereunder. and that revocation or termination hcreuf shall be ineffective as to such third party unless and until actual notice or knowledge of such revocation or termination shall have been received by such third party_ I, for myself and my heirs, executors,, legal repre entativcs and assigns. hereby agree to indemnity and hold harmless any such third party from and against any and all claims that may arise against such third party by reason of such third party having relied upon the provisions of this power of attorney. This power of attorney' shall be governed by Nebraska law. although I request that it be honored in any state or other location in which 1 or myproperty may be found. If any provisions hereof shall be unenforceable or invalid, such unenforceability or invalidity shall not al ect the remaining provisions of this power of attorney. I W ITNFSS WI I MEM", I have executed this power of attorney this 15th day °I -September, 2021. 4