CONFIDENTIAL: The medical information in the form above is confidential and protected by both State and Federal Law. It is unlawful for unauthorized persons to review, copy, disclose, or disseminate confidential medical information. If the reader of this warning is not the intended recipient of the form, or the intended recipient’s agent, you are hereby notified that you have received this form in error and that review or further disclosure of the information contained in this form is strictly prohibited. If you receive this form in error, please notify us immediately and destroy these documents.