I understand that signing this Authorization is voluntary. I understand that my receipt of treatment or eligibility for health benefits will not be conditioned on whether I sign this Authorization, and I will still be able to use the mscripts Mobile Pharmacy Service as a registered user if I do not sign this Authorization. I also understand that if I choose not to sign this Authorization, my choice will not impact or otherwise limit my pharmacy’s or mscripts’ use or disclosure of my information for purposes and activities that do not require my Authorization under applicable law, which includes certain adherence and other health-related communications including refill and pickup reminders and weekly pharmacy offerings. I understand that any of my information disclosed pursuant to this Authorization may be subject to re-disclosure by the recipient and no longer protected by HIPAA.
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This Authorization is valid until revoked or three (3) years from the date signed, whichever occurs first. I may revoke this Authorization at any time by:

If I choose to revoke this Authorization it will not be effective to the extent that my pharmacy or mscripts has already used or disclosed my information in reliance on this Authorization.
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I can obtain a copy of this HIPAA Authorization on my “Account” page in my Mobile Pharmacy Service mobile application.