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