Release Of Information For Mental Health In Bronx

State:
Multi-State
County:
Bronx
Control #:
US-00458
Format:
Word; 
Rich Text
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Description

The Release of Information for Mental Health in Bronx is a critical document that allows individuals to authorize the sharing of their mental health records with specified parties, such as healthcare providers or legal representatives. This form ensures that sensitive information is disclosed only to those who require it for legitimate purposes, like legal proceedings or medical care. Key features of this form include clear sections for the authorized individual's details, the name of the recipient, and a declaration of liability release for the recipient. Filling out the form involves providing personal information, including Social Security number, and a clear signature to validate the authorization. It is important to keep in mind that this authorization remains active until revoked in writing. Attorneys, partners, owners, associates, paralegals, and legal assistants will find this form useful for cases involving mental health assessments, legal representation, or any context requiring mental health information sharing. Proper utilization of this form can facilitate communication between mental health professionals and legal entities, promoting an efficient workflow while protecting the rights and privacy of individuals involved.

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FAQ

The NYS Department of Health, however, requires medical doctors to retain records for any adult patients for 6 years. Minor patients are kept for 6 years and until one year after the minor reaches the age of 18 (whichever is longer). For hospitals, medical records must be kept for six years from the date of discharge.

To request a copy of a medical record from a hospital, call or write to the hospital holding the record. You must speak to the Medical Records Department and request a release of medical information authorization form from the hospital.

Authorization. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.

To request a copy of a medical record from a physician, call or write to the physician holding the record. If the physician does not respond to this request within a timely manner, you can file a complaint with the NYS Department of Health, Office of Professional Medical Conduct for Physicians.

New York State Law requires all health care practitioners and facilities to allow patients to have access to their health records. However, some restrictions may apply. This form describes your rights, what information is available and how to appeal if access to health records is denied.

Requests for Client Records If you are submitting a request for Medicaid records specifically, please fill out and submit the OCA-960 Authorization for Release of Health Information Pursuant to HIPAA or other HIPAA-compliant form. Requests and forms should be submitted via email to HIPAA@dss.nyc.

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

How you make your request will depend on your provider's processes. You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access—send an email, or mail or fax a letter to your provider.

Submit a request for records in person: The Department of Health's main offices are located in the Corning Tower, Empire State Plaza, Albany, New York. Upon entering the main entrance of the building, advise Security Staff that you would like to request records.

960 for new enrollees when seeking authorization of the release of enrollee's (or prospective enrollee's) protected health information. MLTC plans should assist the individual in understanding the content of the form. The authorization must be signed and dated and the enrollee must receive a signed copy.

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Release Of Information For Mental Health In Bronx