Doh 2557-2026

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The document is an 'Authorization for Release of Health Information and Confidential HIV-Related Information' form from the New York State Department of Health AIDS Institute. It allows individuals to authorize the release of their health information, including HIV-related data, under specific conditions and legal protections. The form outlines the types of information that can be disclosed, the entities that may receive this information, and the legal implications of unauthorized disclosure. It also provides contact information for further inquiries regarding HIV confidentiality and federal privacy protection.

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Click ‘Get Form’ to open the doh 2557 in the editor.
Begin by selecting which type of health information you wish to release. Check the appropriate boxes for 'My HIV-related information', 'My non-HIV health information', or 'Both'.
Fill in the name and address of the facility or person disclosing your HIV-related information. Ensure accuracy for proper communication.
Provide the name of the individual whose information will be released, along with your relationship to that person if applicable.
Describe the specific information to be released and state the reason for this release clearly.
Indicate the time period during which this release is authorized by filling in the 'From' and 'To' dates.
Review all entries for accuracy before signing at the bottom of the form. Your signature confirms consent for disclosure.

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (483 Votes)
2005	4 Satisfied (52 Votes)

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What is New York State Public Health Law Article 13 F?

Article 13-F Section 1399-CC of the Public Health Law prohibited the sale of tobacco and vapor products and smoking paraphernalia to people under the age of 21.

How to fill out authorization for release of health information pursuant to HIPAA?

Public Health Law, Article 27-F: Requires that any person or facility whose work is covered by Article 27-F and who receives HIV-related information MUST keep that information confidential, as required by law.

What is Article 27 F of the New York State Public Health Law?

1. Purpose. The New York State HIV confidentiality laws (including Articles 21, 23, and 27-F of the Public Health Law) strictly protect the confidentiality of information about individuals who have undergone HIV-related testing, are living with HIV, or are contacts of individuals living with HIV.

What is Article 33 NY Public Health Law?

The purposes of this article are: 1. to combat illegal use of and trade in controlled substances; and 2. to allow legitimate use of controlled substances in health care, including palliative care; veterinary care; research and other uses authorized by this article or other law; under appropriate regulation and subject

Doh 2557-2026

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What is New York State Public Health Law Article 13 F?

How to fill out authorization for release of health information pursuant to HIPAA?

What is Article 27 F of the New York State Public Health Law?

What is Article 33 NY Public Health Law?

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Doh 2557-2026

Here's how it works

How to use or fill out doh 2557 with our platform

See more doh 2557 versions

Complete this form in 5 minutes or less

Got questions?

What is New York State Public Health Law Article 13 F?

How to fill out authorization for release of health information pursuant to HIPAA?

What is Article 27 F of the New York State Public Health Law?

What is Article 33 NY Public Health Law?

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