S.B. No. 1565
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 Date [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):
[ ] To facilitate the investigation and evaluation of
the health care claim described in the accompanying Notice of
Health Care Claim.
[ ] 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 written and electronic
and is specifically described as follows:
1. The health information and billing records in the
custody of the 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.__________________________
This authorization extends to an additional physician or
health care provider 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
only if the claimant gives notice to the recipient of the attached
Notice of Health Care Claim of that additional physician or health
care provider;
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 and current addresses of treating physicians or
health care providers, if applicable:
1.__________________________
2.__________________________
3.__________________________
4.__________________________
5.__________________________
6.__________________________
7.__________________________
8.__________________________
C. Exclusions
1. Providers excluded from authorization.
The following constitutes a list of physicians or health care
providers possessing health care information concerning __________
(patient) to whom 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 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 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 at any time by giving notice in writing to
the person or persons named in Section B above of my intent to
revoke this authorization. I understand that prior actions taken
in reliance on this authorization by a person that had permission to
access my protected health information will not be affected. 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
__________
Description of Personal or Legal Representative's Authority
__________
Date
_______________
SECTION 2. This Act takes effect September 1, 2019.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1565 passed the Senate on
April 24, 2019, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1565 passed the House on
May 10, 2019, by the following vote: Yeas 141, Nays 0, two
present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor