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Click ‘Get Form’ to open the doh 2557 in the editor.
Begin by checking the appropriate boxes to indicate which type of information you consent to release: HIV-related information, non-HIV medical information, or both.
Fill in the name and address of the facility or person disclosing your medical information in the designated fields.
Provide the name of the individual whose information will be released, along with your relationship to that person if applicable.
Describe the specific information you wish to be released and state the reason for this release in the provided sections.
Indicate the time period during which this authorization is valid by filling in the start and end dates.
Review all entries for accuracy before signing and dating the form at the bottom.
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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 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.
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
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