86R13835 BRG-F
 
  By: Smith H.B. No. 3248
 
 
 
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 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 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, 2019.