members of the Medical Staff, or Board, and any third party who provides information involved in the action for all costs incurred in defending such legal action, including costs and attorneys’ fees, and expert witness fees.
( e) Authorization to Share Information Among Affiliated Entities:
The individual authorizes affiliated entities to share information pertaining to the individual’ s clinical competence, professional conduct, and health. This information and documentation may be shared at any time, including, but not limited to, any evaluation of an individual’ s qualifications, any periodic reassessment of those qualifications, or when a question is raised about the individual.
( f) Authorization to Obtain Information from Third Parties:
The individual authorizes the Hospital, Medical Staff Leaders, and their representatives to consult with any third party who may have information relating to the individual’ s professional competence or conduct or any other matter relating to their qualifications for initial or continued appointment, and to obtain communications, reports, records, and other documents of third parties that may be relevant to such questions. The individual also specifically authorizes third parties to release this information to the Hospital and its authorized representatives upon request and waives the right to review any of the information provided.
( g) Authorization to Disclose Information to Third Parties:
The individual authorizes the Hospital, Medical Staff Leaders, and their representatives, to disclose information to other hospitals, health care facilities, managed care organizations, government regulatory and licensure boards or agencies, and their representatives to assist them in evaluating the individual’ s qualifications. Any requests for information regarding a protected peer review matter will require a release of information specific to the matter at hand.
( h) Authorization for Criminal Background Check:
The individual agrees to sign consent forms to permit a consumer reporting agency to conduct a criminal background check and report the results to the Hospital and allow this form to be shared with both the Hospital and the Medical Staff.
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