OCA Form 960, Authorization to Release Health Information Pursuant to HIPAA, is a legal document signed by a patient that gives consent to the release of health information within the state of New York. This document gives permission to use protected health information for certain purposes - treatment, payment, and operations, and disclose protected health information to third parties specified by the patient. It ensures the protection of the patients' privacy and allows health data to flow freely between authorized parties for healthcare activities.
If you are seeking your own medical records or wish to give another individual or agency permission to do so on your behalf, complete OCA Official Form 960.
This form was released by the New York State Office of Court Administration. It has replaced Form MAP-751D (Authorization for Disclosure of Health Information) in May 2016. You can download an OCA Form 960 fillable version through the link below.