We will not disclose your medical records to others without your consent or unless the law authorizes or compels us to do so. Our Notice of Privacy Practices describes in greater detail how your health information may be used and disclosed. (Copies are available at the reception.) I understand that I am financially responsible for the payment of medical services received. I may be responsible for any balance not covered by my insurance and I hereby authorize Manhattan Family Practice to furnish any necessary medical or incidental information concerning my medical care and treatment to my insurance carriers.