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.
Spectrum: Partisan Bill (Republican 2-0)
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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[ |
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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 |