he release or disclosure of HIV-related information, you may contact the New York State Division of Human Rights at (800) 523-2437/(212) 480-2493 or the New York City Commission on Human Rights at (212) 306-7450. By signing this authorization form, I am authorizing the use or disclosure of my protected health information as described above.

he retease or disclosure of HIV-related information, you may contact the New York State Division of Human Rights at (800) 523-2437/(212) 480-2493 or the New York City Commission on Human Rights at (212) 306-7450. By signing this authorization form, I am authorizing the use or disclosure of my protected health information as described above.