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Medicaid Alert 4.4.16: MAP 751d is replaced by OCA 960 Download
MAP 751d is replaced by OCA 960 form.pdf
HRA alert replacing MAP 751d with OCA 960 effective immediately.
05 Apr, 2016 1.18 mb Downloads: 7655
HIPAA Compliant Authorization Form 1-2013 Download
HIPAA Compliant Authorization Form 1-2013.pdf
HIPAA form
13 Apr, 2015 47 kb Downloads: 10055
Statement Template - New York State Law.doc Download
17 Mar, 2015 26 kb Downloads: 4813
Letter Accompanying Statement Template.doc Download
17 Mar, 2015 27 kb Downloads: 4175
Template of Medical Record Statement Download
Statement Template - New York State Law.doc
22 Aug, 2012 24 kb Downloads: 3569
Template of Letter Accompanying Medical Record Statement Download
Letter Accompanying Statement Template.doc
22 Aug, 2012 25 kb Downloads: 3476
HIPAA form adapted to request claims history from EPIC Download
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
15 Aug, 2011 37 kb Downloads: 387
Form MAP-751D - Authorization for Disclosure of Individual Health Information Download
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.
05 Nov, 2010 289 kb Downloads: 53459
Sklar Power of Attorney (POA) Download
Sklar POA.pdf
Special Power of Attorney granting authority to execute HIPAA releases on behalf of principal
11 Jun, 2010 18 kb Downloads: 12817
HIPAA Privacy Rule Download
HIPAA Privacy Rule 8_19_09.pdf
Overview of HIPAA privacy rule
26 Aug, 2009 87 kb Downloads: 48140
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