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Brookdale University Hospital Authorization For Release Of Medical Records 2018
Get Brookdale University Hospital Authorization For Release Of Medical Records 2018-2024
P Home Cell I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form. In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: 1. This authorization may include disclosure of information relating to ALCOHOL AND DRUG ABUSE, MENTAL HEALTH TREATMENT, except 2. 3. 4. 5. 6. psychotherapy notes, and CONFIDENTIAL HIV RELA.
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