Get NY OCA 960

The Health Insurance Portability and Accountability Act (HIPAA) Form 960 is a document that allows for the release of an individual's personal medical information to a specified entity.

Partial Waiver of HIPAA Authorization "A partial waiver of the Authorization requirements of the Privacy Rule might be requested, for instance, to allow a researcher to obtain PHI as necessary to recruit potential research subjects.

Waiver of the HIPAA authorization requirement from the IRB. A waiver is a request to forgo the authorization requirement based on the fact that the disclosure of PHI involves minimal risk to the participant and the research cannot practically be done without access to/use of PHI.

HIPAA Authorization Defined A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.

If you do decide to obtain consent, you have complete discretion to design a process that best suits your needs. By contrast, the Privacy Rule requires an "authorization" for uses and disclosure of protected health information not otherwise allowed by the rule.

OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA.

18 HIPAA Identifiers Name. Address (all geographic subdivisions smaller than state, including street address, city county, and zip code) All elements (except years) of dates related to an individual (including birthdate, admission date, discharge date, date of death, and exact age if over 89) Telephone numbers. Fax number.