Authorization For Release of Health Information Pursuant to HIPAA
Instructions for the Use
of the HIPAA-compliant Authorization Form to
Release Health Information Needed for Litigation
This form is the product of a collaborative process between the New York State
Office of Court Administration, representatives of the medical provider community in
New York, and the bench and bar, designed to produce a standard official form that
complies with the privacy requirements of the federal Health Insurance Portability and Accountability Act (“HIPAA”) and its implementing regulations, to be used to authorize the release of health information needed for litigation in New York State courts. It can, however, be used more broadly than this and be used before litigation has been commenced, or whenever counsel would find it useful.
The goal was to produce a standard HIPAA-compliant official form to obviate the current disputes which often take place as to whether health information requests made in the course of litigation meet the requirements of the HIPAA Privacy Rule. It should be noted, though, that the form is optional. This form may be filled out on line and downloaded to be signed by hand, or downloaded and filled out entirely on paper.
When filing out Item 11, which requests the date or event when the authorization
will expire, the person filling out the form may designate an event such as “at the
conclusion of my court case” or provide a specific date amount of time, such as “3 years from this date”.
If a patient seeks to authorize the release of his or her entire medical record, but
only from a certain date, the first two boxes in section 9(a) should both be checked, and the relevant date inserted on the first line containing the first box.