Category Archives: Forms

*Two HIPAA forms for Interviews and Records

I have added a non-fillable Authorization To Permit Interview Of Treating Physician By Defense Counsel required by Arons v Jutkowitz 9 NY3d 393 (2007) and a fillable** Authorization For Release Of Health Information Pursuant To HIPAA.

Note, the Court website states that these forms “may not be used to obtain … release of psychotherapy notes, see 45 CFR section 164.508” as a specific authorization is necessary to obtain psychotherapy notes. One of these can be found here, although as it is perpared for use in Kentucky, some changes will have to be made in this Word™ document.

**Fillable forms usually cannot be saved with the filled in information (if you don’t have Adobe Acrobat™) and thus must be printed before closing the document, as doing so will cause the filled in information to be lost.

*Claimant’s Authorization to Disclose Workers’ Compensation Board Records

A defense firm has asked me to provide them with an authorization to permit them to obtain my client’s Workers’ Compensation Board Records. They graciously provided me with the form that the WCB requires. But better yet, I found a fillable version on the internet and have added it to my links. There are a large number of such fillable and non fillable forms on the internet and as I have occasion to use them, I will add them to my links. If there is a governmental form you would like to see there, just let me know with a comment, and I will try and find it and if successful, will add it to my links.

When providing this form to a defense firm or insurance carrier, I suggest crossing out that portion of the form which states that the claimant/plaintiff “authorize[s] the Workers’ Compensation Board to discuss the above-referenced Workers’ Compensation Board records with” the defense firm or insurance carrier, since it is unlikely that such permission was requested and the authorization should be limited to the request.