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HIPAA Forms and Health Information Access and Privacy - Overview

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Posted: 11 Jun, 2010
by David Silva (New York Legal Assistance Group)
Updated: 06 Jun, 2019
by Valerie Bogart (New York Legal Assistance Group)

You have the right to privacy concerning information about your health, medical care, and how your care is paid for.  This right comes from a federal law called HIPAA (Health Insurance Portability and Accountability Act).  Although HIPAA regulates many other areas, the main impact it has on most people is the Privacy Rule, which determines how health care providers and health insurance companies can disclose Protected Health Information (PHI).

The Legal Aid Society has written an article explaining the HIPAA Privacy Rule, as well as answering many common questions about how it operates.

One of the most common situations in which people confront HIPAA is when they are trying to get a medical provider or health plan to disclose their Protected Health Information to another party.  In order to do this, you generally need a HIPAA Release, which is a signed authorization from the patient.  Some agencies and providers prefer to have a HIPAA release on their own specialized form, although this is not legally required.  In fact, since November 2013, Managed Long Term Care, PACE, and Medicaid Advantage Plus plans have been REQUIRED to accept the NYS Office of Court Administration OC-960 form below.  See DOH MLTC Policy 13.24 

Right to Your Own Records -- This  2015 memo from the U.S. Health and Human Services Office of Civil Rights  enumerates patients’ rights to access their medical records.  In part, it provides authority that members of managed care insurance plans -- including Medicaid plans - have a right to their records at any time, not only when a hearing or other appeal is pending.   See also NYS DOH  Managed Long Term Care Guide  p. 17.  

Here are some examples of organization-specific HIPAA forms:

  1. New York State Office of Court Administration

    OCA Form No. 960 - Authorization for Release of Health Information Pursuant to HIPAA


  1. New York State Department of Health

DOH-2557 - HIPAA Compliant Authorization for Release of Medical Information and Confidential HIV Related Information (English)
DOH-2557 - Autorización para divulgar información médica e información confidencial relativa al VIH conforme a la ley de Responsabilidad y Transferibilidad de Seguros Médicos (HIPAA) (Español)

Myths and Facts About HIPPA - and Other Resources

Advocates often find that although HIPAA was intended to protect consumers, the law is often abused by agency or health provider or insurance  staff as a way to obstruct an individual's access to their own health information, or to refuse to provide even general information regarding agency practices. 

Q:  Does the Privacy Rule require that an authorization be notarized or include a witness signature?
A:  The Privacy Rule does not require that a document be notarized or witnessed.

  • It is possible for an individual to appoint an agent using a Power of Attorney (POA) to execute HIPAA releases on his or her behalf.  The new Power of Attorney form in New York State contains a clause giving the agent the authority to examine, question, and pay medical bills on behalf of the principal, so long as the principal has executed a health care proxy.  In addition, it is possible to execute a POA exclusively for purposes of executing HIPAA releases, known as a "Sklar POA."


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.


Attached files
item MAP 751d is replaced by OCA 960 form.pdf (1.18 mb) Download
item HIPAA Privacy Rule 8_19_09.pdf (87 kb) Download
item HRA_9_08span.pdf (316 kb) Download
item Sklar POA.pdf (18 kb) Download

External links
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.health.state.ny.us/forms/doh-2557.pdf
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.health.state.ny.us/forms/doh-2557es.pdf
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.nycourts.gov/forms/Hipaa_fillable.pdf
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.empirejustice.org/issue-areas/disability-benefits/ssi-ssd/ssa-issues/new-york-revises-power-of.html
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.cdt.org/files/pdfs/20080311mythsfacts.pdf
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.cdt.org/files/pdfs/20090109mythsfacts2.pdf

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