I understand that this consent is valid until it is revoked by me. I understand that I may revoke this consent at any time by giving written notice of my desire to do so, to the physician. I also understand that I will not be able to revoke this consent in cases where the physician has already relied on it to use or disclose my health information. Written revocation of consent must be sent to the physician’s office. The patient acknowledges that this practice is using an electronic health record information system (the “EHR System”), in coordination with Northwestern Memorial HealthCare, which is the parent organization for Northwestern Memorial Hospital (NMH) and Northwestern Lake Forest Hospital (NLFH). The collection and use of all information through the EHR System is primarily for the purpose of treatment of patients by this medical practice, NMH, NLFH, and other medical practices of physicians on staff at either hospital who have a treatment relationship with the patient and provide services in a clinically integrated care setting. All information collected through the EHR System may also be shared with, and used by, NMH, NLFH and certain other hospitals, academic institutions, and health care providers that perform medical or research activities in conjunction with NMH and NLFH (including but not limited to, Northwestern University, the Feinberg School of Medicine, Children’s Memorial Hospital, and the Rehabilitation Institute of Chicago) for the following health-related activities, including without limitation: (a) conducting peer review; (b) promoting quality assurance; (c) mortality and morbidity analysis; (d) conducting utilization review; (e) evaluating and improving the quality _of care; (f) promoting and maintaining professional standards; (g) examining costs and maintaining cost control; (h) conducting medical audits; (i) assisting the medical staff membership and credentialing process; (j) performing data quality management; (k) improving the efficiency and effectiveness of healthcare; (I) conducting research in a manner that complies with applicable law; (m) copying data from the EHR System and any related database and incorporating it into a data warehouse maintained by Northwestern University which may be accessed for any of the activities described above or in the Practice Privacy Notice. The patient further acknowledges that the information in the EHR System will contain information regarding treatment for mental health and developmental disabilities, HIV, AIDS, substance abuse, and genetic testing and counseling, and consents to the use and disclosure of such information for treatment, payment purposes, and those activities described above and in the Practice Privacy Notice as such consent may be required by state law.