Authorization and Release
I authorize Desert Regional Medical Center Graduate Medical Education ("DRMCGME") department and its DRMCGME system affiliates, including respective individual employees, officers, representatives and agents, to verify all sources and information in any form from my graduate medical education file that DRMCGME deems relevant to the verification of my postgraduate training. I understand and agree that such information may include, without limitation, information relating to my education and training, character, and professional competence (including quality assurance and other privileged information). I hereby authorize DRMCGME, its employees, or agents for this purpose to provide all such information to the verifying agent. I acknowledge that DRMCGME, its officers and employees, and all such other individuals, institutions, and organizations may rely upon my authorization contained in this document and need to seek no further consent from me for this purpose. I further understand and acknowledge that all such disclosures made in good faith shall be subject to immunity provisions of federal, state, and local laws.
I hereby release from all liability DRMCGME and their employees, officers and agents, and such other individuals, institutions or organizations, and assignees for all acts performed and statements made in good faith and without malice in connection with the request.
