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Attachment D <br />AUTHORIZATIONTO RELEASE AND DISCLOSE <br />INFORMATION AND DOCUMENTS <br />TO: BUILDING AND CONSTRUCTION RESOURCE CENTER, INC., <br />BCRC ADMINISTRATORS, INC., AND THEIR OFFICERS, <br />EMPLOYEES, AGENTS, AND INDEPENDENT CONTRACTORS <br />6050 Southport Road, Suite B <br />Portage, Indiana 46368 <br />I, <br />hereby authorize the entities and <br />individuals referred to above (hereinafter referred to collectively as `BCRC") to <br />release and disclose the following information and documents in their possession <br />and/or control, concerning me and/or any drug and/or alcohol testing of me: <br />Drug and alcohol testing information and documents related thereto <br />Test results for drug and alcohol testing <br />Communications regarding drug and alcohol testing and test results <br />Referrals and follow-up reviews (e.g., to EAP, MRO, etc.) <br />Other (Must Specify): <br />[NOTE: If you do not authorize the release and disclosure of any of the items <br />listed above, then you need to draw a line through any of the items listed above <br />that you are not authorizing. If you want to authorize the release and disclosure <br />of any other items, please list such items on the line listed above that follows <br />"Other (Must Specify).] <br />to the following entities and individuals (hereinafter referred to collectively <br />as the "Receiving Parties") and to communicate with the Receiving Parties <br />concerning such information and documents: <br />Terms and Conditions: <br />1. I understand and acknowledge that I am hereby authorizing BCRC <br />to release and disclose information and documents, and to communicate with <br />the Receiving Parties concerning such information and documents, even though <br />such information, documents, and communications may be protected from <br />disclosure by federal laws, state laws, and/or BCRC policies. <br />