Bill Text: TX HB2891 | 2017-2018 | 85th Legislature | Enrolled
Bill Title: Relating to the medical authorization required to release protected health information in a health care liability claim.
Sponsorship: Partisan Bill (Republican 2)
Status: (Passed) 2017-06-09 - Effective immediately [HB2891 Detail]
Download: Texas-2017-HB2891-Enrolled.html
| H.B. No. 2891 | ||
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| 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): | ||
| [ ] [ |
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| of the health care claim described in the accompanying Notice of | ||
| Health Care Claim.[ |
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| [ ] [ |
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| 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 [ |
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| electronic and is specifically described as follows: | ||
| 1. The health information and billing records in the | ||
| custody of the [ |
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| 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._______________________ [ |
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| This authorization extends [ |
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| additional physician [ |
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| [ |
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| __________ (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 [ |
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| [ |
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| if applicable:[ |
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| 1. | ||
| 2. | ||
| 3. | ||
| 4. | ||
| 5. | ||
| 6. | ||
| 7. | ||
| 8. | ||
| C. Exclusions | ||
| 1. Providers excluded from authorization. | ||
| The [ |
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| a list of physicians or health care providers possessing health | ||
| care information concerning __________ (patient) to whom [ |
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| 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 [ |
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| 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.__________________________[ |
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| 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 [ |
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| 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 | ||
| [ |
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| __________ | ||
| [ |
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| [ |
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| 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. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I certify that H.B. No. 2891 was passed by the House on April | ||
| 27, 2017, by the following vote: Yeas 143, Nays 1, 3 present, not | ||
| voting; and that the House concurred in Senate amendments to H.B. | ||
| No. 2891 on May 26, 2017, by the following vote: Yeas 144, Nays 0, | ||
| 3 present, not voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| I certify that H.B. No. 2891 was passed by the Senate, with | ||
| amendments, on May 24, 2017, by the following vote: Yeas 31, Nays | ||
| 0. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| APPROVED: __________________ | ||
| Date | ||
| __________________ | ||
| Governor | ||
