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Oca 960 form pdf 2026

The document is a HIPAA-compliant authorization form for the release of health information in New York State. It allows patients to authorize the disclosure of their medical records, including sensitive information related to alcohol and drug abuse, mental health treatment, and HIV-related information. The form outlines the patient's rights regarding the release of their information, including the ability to revoke consent and the voluntary nature of signing the form. It aims to standardize the process for obtaining health information needed for litigation while ensuring compliance with privacy regulations.

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Click ‘Get Form’ to open the oca 960 form in the editor.
Begin by entering the Patient Name, Date of Birth, and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the Patient Address to provide a complete contact detail. This helps in ensuring that any correspondence regarding health information reaches you.
In Item 7, specify the name and address of the health provider or entity from whom you are requesting information. This is essential for processing your request.
Proceed to Item 8 and indicate the name and address of the person(s) or category of persons who will receive this information.
In Item 9(a), select the specific information you wish to release by checking the appropriate boxes. If necessary, initial next to any sensitive information types you authorize for disclosure.
Complete Items 10 through 13 by providing reasons for release, signing, and dating the form. Make sure all required fields are filled out before submission.

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