This authorization shall cover LifeStyle Medical Center and all of their respective employees, workforce, and business associates.
This authorization may be revoked at any time, provided that the revocation is executed in writing to the LifeStyle Medical Center Chief Compliance Officer at 10208 Cerny St, STE 301, Raleigh, NC 27617. Revocation will not affect any disclosures acting upon by the disclosure and prior to request for revocation. Information disclosed pursuant to this authorization may be re-disclosed and is no longer protected by federal and state privacy rules. Authorization of disclosure of the above information is voluntary and this authorization is not intended to alter the patient's ability to receive medical care from any health care provider.