<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:"Vladimir Script";
panose-1:3 5 4 2 4 4 7 7 3 5;}
@font-face
{font-family:Garamond;
panose-1:2 2 4 4 3 3 1 1 8 3;}
@font-face
{font-family:Nyala;
panose-1:2 0 5 4 7 3 0 2 0 3;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Consolas;
panose-1:2 11 6 9 2 2 4 3 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:purple;
text-decoration:underline;}
p.msonormal0, li.msonormal0, div.msonormal0
{mso-style-name:msonormal;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
span.EmailStyle18
{mso-style-type:personal-reply;
font-family:"Calibri",sans-serif;}
.MsoChpDefault
{mso-style-type:export-only;
font-family:"Calibri",sans-serif;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="blue" vlink="purple">
<div class="WordSection1">
<p class="MsoNormal">Have used this one, not of my creation, several times.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Heather<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:16.0pt;font-family:"Vladimir Script";color:#1F497D">Heather S. de Vrieze</span><b><span style="font-size:16.0pt;color:#1F497D"><br>
</span></b><i><span style="font-family:"Garamond",serif;color:#1F497D">Attorney-at-Law<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-family:"Garamond",serif;color:#1F497D"><img width="189" height="105" style="width:1.9701in;height:1.097in" id="_x0000_i1026" src="cid:image003.jpg@01D475EB.3FE25970" alt="cid:image001.jpg@01D013C2.30F35160"></span></i><i><span style="font-size:12.0pt;font-family:"Garamond",serif;color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">3909 California Avenue SW<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">Seattle, WA 98116-3705
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">(206)938-5500
<o:p></o:p></span></p>
<p class="MsoNormal"><a href="mailto:heatherd@westseattlelaw.com"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">heatherd@westseattlelaw.com</span></a><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">
<o:p></o:p></span></p>
<p class="MsoNormal"><a href="http://www.westseattlelaw.com/"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">www.westseattlelaw.com</span></a><span style="font-size:10.0pt;font-family:Nyala;color:#44524E">
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:Nyala;color:#44524E"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:#002E8A">Click here to connect with de Vrieze | Carney on Facebook:
</span></b><b><span style="color:#1F497D"> </span></b><a href="https://www.facebook.com/DeVriezeCarney"><b><span style="text-decoration:none"><img border="0" width="72" height="21" style="width:.7462in;height:.2238in" id="Picture_x0020_1" src="cid:image004.png@01D475EB.3FE25970" alt="FB Logo"></span></b></a><span style="font-family:Nyala;color:#44524E"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:8.0pt;color:#A6A6A6"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:8.0pt;color:#A6A6A6">CONFIDENTIAL & PRIVILEGED. This e-mail message may contain legally privileged and/or confidential information. If you have received this e-mail in error, please notify the sender immediately
and delete all copies of this e-mail message and any attachment.</span><span style="font-size:16.0pt;font-family:"Cambria",serif;color:blue"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b>From:</b> wsbapt-bounces@lists.wsbarppt.com <wsbapt-bounces@lists.wsbarppt.com>
<b>On Behalf Of </b>Jamia Burns<br>
<b>Sent:</b> Tuesday, November 06, 2018 3:54 PM<br>
<b>To:</b> WSBA Probate & Trust Listserv <wsbapt@lists.wsbarppt.com><br>
<b>Subject:</b> [WSBAPT] HIPPA Release<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<p class="MsoNormal">Does anyone have a stand alone HIPPA release that you are willing to share? I have a client who is naming his daughter as power of attorney, but still wants his life partner to be able to communicate with medical professionals. Thank you! <o:p></o:p></p>
<div>
<p class="MsoNormal"> <br clear="all">
<o:p></o:p></p>
<div>
<div>
<div>
<div>
<div>
<div>
<div>
<div>
<div>
<div>
<div>
<p class="MsoNormal">Jamia S. Burns<br>
Attorney at Law<br>
(360) 739-6379<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:9.5pt">Office: 1200 Dupont St., Suite 1-D<o:p></o:p></span></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:9.5pt">Bellingham, WA 98225 (By Appointment Only)</span><o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Mail: P.O. Box 29453<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Bellingham, <span style="color:black">WA 98228</span><o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><span style="color:black"><a href="mailto:jamia@jamiaburnslaw.com" target="_blank">jamia@jamiaburnslaw.com</a></span><o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><span style="color:black"><a href="http://www.jamiaburnslaw.com" target="_blank">www.jamiaburnslaw.com</a></span><o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:8.0pt;font-family:"Arial",sans-serif;background:white">NOTICE: This e-mail may contain confidential or privileged material and is intended for use solely by the above-referenced recipient. Any review, copying, printing,
disclosure, distribution, or other use by any other person or entity is strictly prohibited. If you are not the named recipient, or believe you have received this e-mail in error, please reply to the sender and delete the copy you received. Thank you.</span><o:p></o:p></p>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>