85R9206 CAE-F
By: Creighton S.B. No. 1872
A BILL TO BE ENTITLED
AN ACT
relating to the medical authorization required to release protected
health information in a health care liability claim.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 74.052(c), Civil Practice and Remedies
Code, is amended to read as follows:
(c) The medical authorization required by this section
shall be in the following form and shall be construed in accordance
with the "Standards for Privacy of Individually Identifiable Health
Information" (45 C.F.R. Parts 160 and 164).
AUTHORIZATION FORM FOR RELEASE OF PROTECTED HEALTH INFORMATION
Patient Name:______ Patient Place of Birth:________
Patient Address:
____________ Street_________________ City, State, ZIP
Patient Telephone:__________ Patient E-mail:_________
NOTICE TO PHYSICIAN OR HEALTH CARE PROVIDER: THIS
AUTHORIZATION FORM HAS BEEN AUTHORIZED BY THE TEXAS LEGISLATURE
PURSUANT TO SECTION 74.052, CIVIL PRACTICE AND REMEDIES CODE. YOU
ARE REQUIRED TO PROVIDE THE MEDICAL AND BILLING RECORDS AS
REQUESTED IN THIS AUTHORIZATION.
A. I, __________ (name of patient or authorized
representative), hereby authorize __________ (name of physician or
other health care provider to whom the notice of health care claim
is directed) to obtain and disclose (within the parameters set out
below) the protected health information and associated billing
records described below for the following specific purposes (check
all that apply):
[ ] [1.] To facilitate the investigation and evaluation
of the health care claim described in the accompanying Notice of
Health Care Claim.[; or]
[ ] [2.] Defense of any litigation arising out of the
claim made the basis of the accompanying Notice of Health Care
Claim.
[ ] Other - Specify:_________________
B. The health information to be obtained, used, or disclosed
extends to and includes the verbal as well as [the] written and
electronic and is specifically described as follows:
1. The health information and billing records in the
custody of the [following] physicians or health care providers who
have examined, evaluated, or treated __________ (patient) in
connection with the injuries alleged to have been sustained in
connection with the claim asserted in the accompanying Notice of
Health Care Claim.
Names and current addresses of treating physicians or
health care providers:
1.__________________________
2.__________________________
3.__________________________
4.__________________________
5.__________________________
6.__________________________
7.__________________________
8._______________________ [(Here list the name and
current address of all treating physicians or health care
providers).]
This authorization shall extend to any additional physicians
or health care providers that may in the future evaluate, examine,
or treat __________ (patient) for injuries alleged in connection
with the claim made the basis of the attached Notice of Health Care
Claim;
2. The health information and billing records in the
custody of the following physicians or health care providers who
have examined, evaluated, or treated __________ (patient) during a
period commencing five years prior to the incident made the basis of
the accompanying Notice of Health Care Claim.
Names [(Here list the name] and current addresses
[address] of treating [such] physicians or health care providers,
if applicable:[.)]
1.
2.
3.
4.
5.
6.
7.
8.
C. Exclusions
1. Providers excluded from authorization.
The [Excluded Health Information--the] following constitutes
a list of physicians or health care providers possessing health
care information concerning __________ (patient) to whom [which]
this authorization does not apply because I contend that such
health care information is not relevant to the damages being
claimed or to the physical, mental, or emotional condition of
__________ (patient) arising out of the claim made the basis of the
accompanying Notice of Health Care Claim. List the names [(Here
state "none" or list the name] of each physician or health care
provider to whom this authorization does not extend and the
inclusive dates of examination, evaluation, or treatment to be
withheld from disclosure, or state "none":
1.__________________________
2.__________________________
3.__________________________
4.__________________________
5.__________________________
6.__________________________
7.__________________________
8.__________________________[.)]
2. By initialing below, the patient or patient's
personal or legal representative excludes the following
information from this authorization:
________ HIV/AIDS test results and/or treatment
________ Drug/alcohol/substance abuse treatment
________ Mental health records (mental health records
do not include psychotherapy notes)
________ Genetic information (including genetic test
results)
D. The persons or class of persons to whom the patient's
health information and billing records [of __________ (patient)]
will be disclosed or who will make use of said information are:
1. Any and all physicians or health care providers
providing care or treatment to __________ (patient);
2. Any liability insurance entity providing liability
insurance coverage or defense to any physician or health care
provider to whom Notice of Health Care Claim has been given with
regard to the care and treatment of __________ (patient);
3. Any consulting or testifying experts employed by or
on behalf of __________ (name of physician or health care provider
to whom Notice of Health Care Claim has been given) with regard to
the matter set out in the Notice of Health Care Claim accompanying
this authorization;
4. Any attorneys (including secretarial, clerical,
experts, or paralegal staff) employed by or on behalf of __________
(name of physician or health care provider to whom Notice of Health
Care Claim has been given) with regard to the matter set out in the
Notice of Health Care Claim accompanying this authorization;
5. Any trier of the law or facts relating to any suit
filed seeking damages arising out of the medical care or treatment
of __________ (patient).
E. This authorization shall expire upon resolution of the
claim asserted or at the conclusion of any litigation instituted in
connection with the subject matter of the Notice of Health Care
Claim accompanying this authorization, whichever occurs sooner.
F. I understand that, without exception, I have the right to
revoke this authorization in writing. I further understand the
consequence of any such revocation as set out in Section 74.052,
Civil Practice and Remedies Code.
G. I understand that the signing of this authorization is
not a condition for continued treatment, payment, enrollment, or
eligibility for health plan benefits.
H. I understand that information used or disclosed pursuant
to this authorization may be subject to redisclosure by the
recipient and may no longer be protected by federal HIPAA privacy
regulations.
Name of Patient
____________________
Signature of Patient/Personal or Legal Representative
__________
[Date
[__________
[Name of Patient/Representative
[__________]
Description of Personal or Legal Representative's Authority
__________
Date
_______________
SECTION 2. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2017.