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CRDMS Advocacy Form In PDF

CRDMS Member:
6a. Is there a deadline for your action?:

WAIVER & CONSENT

I, the undersigned, clearly understand that the CRDMS Advocacy Committee (“Committee”) is composed of volunteer physicians who are serving in an advisory capacity and are not holding themselves out as lawyers.  I understand that the Committee recommends that I seek the advice of an attorney regarding these matters and not rely solely on any advice the Committee may provide. I understand that all information collected by the Committee in this matter will be kept confidential and that discussion of my identity, if necessary, will only occur in a “closed” session of the Board or general meeting and only after obtaining my written consent.  I understand that the Committee shall not be liable for any loss or damage that may occur as a result of my conferring with them.

I have read the paragraph above and fully understand its contents. I choose to seek the advice of the Committee and, hereby, expressly waive any right or legal action I may have against the Advocate, the Committee and against CRDMS. I sign this Waiver & Consent freely and voluntarily and with an understanding of the nature and the consequences of both.