New York HIPAA release form: OCA Form 960, item by item

OCA Official Form No. 960 is the New York court system’s “Authorization for Release of Health Information Pursuant to HIPAA” (New York OCA Official Form No. 960 and its instructions). Its instructions say it came out of work between the Office of Court Administration, medical providers, judges and lawyers, to end disputes over whether litigation requests met the Privacy Rule (New York OCA Official Form No. 960 and its instructions).

The form is optional, and it can be used before a case is filed or whenever counsel finds it useful (New York OCA Official Form No. 960 and its instructions). Its statements match the federal list explained in the general HIPAA release form guide, so a provider can check it quickly.

One limit is printed on the courts’ forms page: neither court HIPAA form may be used to authorize the release of psychotherapy notes (New York State Unified Court System, HIPAA forms). Those need their own authorization under the federal rule (45 CFR 164.508, Authorizations).

The patient signs it, or someone with legal authority to sign for the patient, who then states that authority on the form (New York OCA Official Form No. 960 and its instructions). In practice, a personal injury or malpractice firm, an insurer or a government benefits office fills in most fields and sends it to the client to sign. At the provider, health information management is the department that receives the form, checks it and releases the records.

1. Download the fillable PDF from the New York courts’ HIPAA forms page; it can be completed on screen and signed by hand (New York OCA Official Form No. 960 and its instructions).
2. Fill in one copy for each provider or facility that holds records.
3. Have the patient initial each special category they agree to release, and sign and date the form.
4. Give the patient a copy, then send the original to the provider’s records department with a cover letter.

• Item 9(a) categories left without initials, so HIV, mental health or drug treatment records are withheld (New York OCA Official Form No. 960 and its instructions).
• Psychotherapy notes requested on the form, which the courts say it cannot authorize (New York State Unified Court System, HIPAA forms).
• Expecting the provider to talk to a lawyer when the box in Item 9(b) was never initialed (New York OCA Official Form No. 960 and its instructions).
• A representative’s signature with Items 12 and 13 blank (New York OCA Official Form No. 960 and its instructions).
• Using Form 960 for HIV-related records outside litigation when the provider asks for the Department of Health’s form DOH-2557 (New York State Department of Health form DOH-2557).

The first six items are statements the patient reads; the rest are blanks. The table follows the printed order (New York OCA Official Form No. 960 and its instructions).

• For the entire record from a given date onward, the instructions say to check the first two boxes of Item 9(a) and write the start date on the first line (New York OCA Official Form No. 960 and its instructions).
• For Item 11, the instructions give examples such as “at the conclusion of my court case” or a span like “3 years from this date” (New York OCA Official Form No. 960 and its instructions).

In New York, confidential HIV-related information is any information showing that a person had an HIV-related test or has HIV infection, HIV-related illness or AIDS (New York State Department of Health form DOH-2557). Public Health Law 2782 bars its disclosure except to listed people, such as someone named in a valid release (New York Public Health Law 2782). On Form 960, that information leaves the provider only if the patient initials the HIV line (New York OCA Official Form No. 960 and its instructions).

The Department of Health also publishes form DOH-2557, which lets a patient release non-HIV information, HIV-related information, or both, to several named facilities (New York State Department of Health form DOH-2557). Providers sometimes prefer it when HIV-related records are requested outside a lawsuit.

An insurer asking for HIV-related information outside its claims work needs a dated, written authorization stating the nature of the information and the purposes of the disclosure (New York Public Health Law 2782).

Initialing the alcohol or drug line may not be enough on its own. A federally assisted substance use disorder program may require a consent that meets 42 CFR 2.31, and its SUD counseling notes need a separate consent (42 CFR 2.31, Consent requirements for substance use disorder records).

The courts’ page lists a second document, the Authorization to Permit Interview of Treating Physician by Defense Counsel (New York State Unified Court System, HIPAA forms). It does not release records; it concerns a conversation between defense counsel and a named physician (New York State Unified Court System, HIPAA forms).

The same psychotherapy notes limit applies to it (New York State Unified Court System, HIPAA forms). A plaintiff’s firm usually sees this form from the other side, so check the conditions listed before the client signs.

When a patient or other qualified person asks a New York provider for copies, Public Health Law 18 caps paper copies at 75 cents per page (New York Public Health Law 18, Access to patient information). The same section says a qualified person may not be denied access only because they cannot pay (New York Public Health Law 18, Access to patient information).

No charge applies when the records support an application, claim or appeal for a government benefit or program (New York Public Health Law 18, Access to patient information). Under the federal rule, the provider acts on a patient’s access request within 30 days, with one extension of up to 30 days (45 CFR 164.524, Right of access).

A firm requesting records on a signed authorization may be billed differently from a patient asking for their own copy, so ask the provider for its fee before the records ship.

• New York OCA Official Form No. 960 and its instructions: Lists the form’s items, the initials required for alcohol or drug, mental health and HIV-related information, the attorney discussion box, and instructions on scope, expiration and optional use.
• New York State Unified Court System, HIPAA forms: The two court HIPAA forms may not be used to obtain an authorization for release of psychotherapy notes.
• New York Public Health Law 2782: Limits disclosure of confidential HIV-related information to listed persons, including those named in a release, and sets conditions for insurers.
• New York State Department of Health form DOH-2557: State form to release health information and confidential HIV-related information to named facilities or persons.
• New York Public Health Law 18, Access to patient information: Paper copies may not exceed 75 cents per page, inability to pay cannot be the only reason to deny access, and no charge applies for government benefit claims.
• 45 CFR 164.508, Authorizations: A use or disclosure of psychotherapy notes requires an authorization that may only be combined with another psychotherapy notes authorization; revocation is limited by reliance and by an insurer’s right to contest where coverage was conditioned on it.
• 42 CFR 2.31, Consent requirements for substance use disorder records: A Part 2 consent must carry its own listed elements; SUD counseling notes need a separate consent; a consent for use in legal proceedings cannot be combined with any other consent.
• 45 CFR 164.524, Right of access: A provider must act on an access request within 30 days, with one extension of up to 30 days.