Form EHS-742 Authorization for Release and Disclosure of Medical Information - New York

What Is Form EHS-742?

This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is form EHS-742?
A: Form EHS-742 is the Authorization for Release and Disclosure of Medical Information. It is specific to the state of New York.

Q: What is the purpose of form EHS-742?
A: The purpose of form EHS-742 is to authorize the release and disclosure of medical information to a specified individual or entity.

Q: Who needs to fill out form EHS-742?
A: Any individual who wishes to authorize the release and disclosure of their medical information in the state of New York needs to fill out form EHS-742.

Q: What information is required on form EHS-742?
A: Form EHS-742 requires the individual's name, date of birth, social security number, and specific information regarding the medical information to be released or disclosed.

Q: Is form EHS-742 specific to the state of New York?
A: Yes, form EHS-742 is specific to the state of New York.

Q: Can I use form EHS-742 in other states?
A: No, form EHS-742 is specifically designed for use in the state of New York. Other states may have their own authorization forms.

Q: Can I authorize the release and disclosure of medical information without using form EHS-742?
A: The use of form EHS-742 is recommended for the authorization of release and disclosure of medical information in the state of New York. However, alternative forms may be accepted by some healthcare providers.

Q: How long is form EHS-742 valid for?
A: The validity period of form EHS-742 may vary depending on the healthcare provider or entity requesting the authorization. It is recommended to check with the specific provider or entity for their requirements.