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Medicaid Alert 4.4.16: MAP 751d is replaced by OCA 960
MAP 751d is replaced by OCA 960 form.pdf
HRA alert replacing MAP 751d with OCA 960 effective immediately.
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05 Apr, 2016
1.18 mb
Downloads: 8053
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HIPAA Compliant Authorization Form 1-2013
HIPAA Compliant Authorization Form 1-2013.pdf
HIPAA form
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13 Apr, 2015
47 kb
Downloads: 10520
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Statement Template - New York State Law.doc
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17 Mar, 2015
26 kb
Downloads: 5147
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Letter Accompanying Statement Template.doc
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17 Mar, 2015
27 kb
Downloads: 4521
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Template of Medical Record Statement
Statement Template - New York State Law.doc
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22 Aug, 2012
24 kb
Downloads: 3823
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Template of Letter Accompanying Medical Record Statement
Letter Accompanying Statement Template.doc
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22 Aug, 2012
25 kb
Downloads: 3730
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HIPAA form adapted to request claims history from EPIC
OCA Form 960 - NY Courts HIPAA Release - EPIC.pdf
Adapts the official NYS Office of Court Administration HIPAA form -- http://www.health.state.ny.us/forms/doh-2557.pdf for EPIC
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15 Aug, 2011
37 kb
Downloads: 387
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Form MAP-751D - Authorization for Disclosure of Individual Health Information
MAP-751D HRA HIPAA Release.pdf
Use this form to enable NYC HRA to disclose protected health information to another party (such as an authorized representative). This is the HIPAA release used by the Medicaid program in NYC. Rev. 7/4/03.
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05 Nov, 2010
289 kb
Downloads: 53879
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Sklar Power of Attorney (POA)
Sklar POA.pdf
Special Power of Attorney granting authority to execute HIPAA releases on behalf of principal
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11 Jun, 2010
18 kb
Downloads: 13357
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HIPAA Privacy Rule
HIPAA Privacy Rule 8_19_09.pdf
Overview of HIPAA privacy rule
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26 Aug, 2009
87 kb
Downloads: 48560
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