Bill Text: TX HB3248 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the medical authorization required to release protected health information in a health care liability claim.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-05-10 - Laid on the table subject to call [HB3248 Detail]
Download: Texas-2019-HB3248-Introduced.html
86R13835 BRG-F | ||
By: Smith | H.B. No. 3248 |
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relating to the medical authorization required to release protected | ||
health information in a health care liability claim. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 74.052(c), Civil Practice and Remedies | ||
Code, is amended to read as follows: | ||
(c) The medical authorization required by this section | ||
shall be in the following form and shall be construed in accordance | ||
with the "Standards for Privacy of Individually Identifiable Health | ||
Information" (45 C.F.R. Parts 160 and 164). | ||
AUTHORIZATION FORM FOR RELEASE OF PROTECTED HEALTH INFORMATION | ||
Patient Name:______ Patient Date [ |
||
Birth:________ | ||
Patient Address: | ||
____________ Street_________________ City, State, ZIP | ||
Patient Telephone:__________ Patient E-mail:_________ | ||
NOTICE TO PHYSICIAN OR HEALTH CARE PROVIDER: THIS | ||
AUTHORIZATION FORM HAS BEEN AUTHORIZED BY THE TEXAS LEGISLATURE | ||
PURSUANT TO SECTION 74.052, CIVIL PRACTICE AND REMEDIES CODE. YOU | ||
ARE REQUIRED TO PROVIDE THE MEDICAL AND BILLING RECORDS AS | ||
REQUESTED IN THIS AUTHORIZATION. | ||
A. I, __________ (name of patient or authorized | ||
representative), hereby authorize __________ (name of physician or | ||
other health care provider to whom the notice of health care claim | ||
is directed) to obtain and disclose (within the parameters set out | ||
below) the protected health information and associated billing | ||
records described below for the following specific purposes (check | ||
all that apply): | ||
[ ] To facilitate the investigation and evaluation of | ||
the health care claim described in the accompanying Notice of | ||
Health Care Claim. | ||
[ ] Defense of any litigation arising out of the claim | ||
made the basis of the accompanying Notice of Health Care Claim. | ||
[ ] Other - Specify:_________________ | ||
B. The health information to be obtained, used, or disclosed | ||
extends to and includes the verbal as well as written and electronic | ||
and is specifically described as follows: | ||
1. The health information and billing records in the | ||
custody of the physicians or health care providers who have | ||
examined, evaluated, or treated __________ (patient) in connection | ||
with the injuries alleged to have been sustained in connection with | ||
the claim asserted in the accompanying Notice of Health Care Claim. | ||
Names and current addresses of treating physicians or | ||
health care providers: | ||
1.__________________________ | ||
2.__________________________ | ||
3.__________________________ | ||
4.__________________________ | ||
5.__________________________ | ||
6.__________________________ | ||
7.__________________________ | ||
8.__________________________ | ||
This authorization extends to an additional physician or | ||
health care provider that may in the future evaluate, examine, or | ||
treat __________ (patient) for injuries alleged in connection with | ||
the claim made the basis of the attached Notice of Health Care Claim | ||
only if the claimant gives notice to the recipient of the attached | ||
Notice of Health Care Claim of that additional physician or health | ||
care provider; | ||
2. The health information and billing records in the | ||
custody of the following physicians or health care providers who | ||
have examined, evaluated, or treated __________ (patient) during a | ||
period commencing five years prior to the incident made the basis of | ||
the accompanying Notice of Health Care Claim. | ||
Names and current addresses of treating physicians or | ||
health care providers, if applicable: | ||
1.__________________________ | ||
2.__________________________ | ||
3.__________________________ | ||
4.__________________________ | ||
5.__________________________ | ||
6.__________________________ | ||
7.__________________________ | ||
8.__________________________ | ||
C. Exclusions | ||
1. Providers excluded from authorization. | ||
The following constitutes a list of physicians or health care | ||
providers possessing health care information concerning __________ | ||
(patient) to whom this authorization does not apply because I | ||
contend that such health care information is not relevant to the | ||
damages being claimed or to the physical, mental, or emotional | ||
condition of __________ (patient) arising out of the claim made the | ||
basis of the accompanying Notice of Health Care Claim. List the | ||
names of each physician or health care provider to whom this | ||
authorization does not extend and the inclusive dates of | ||
examination, evaluation, or treatment to be withheld from | ||
disclosure, or state "none": | ||
1.__________________________ | ||
2.__________________________ | ||
3.__________________________ | ||
4.__________________________ | ||
5.__________________________ | ||
6.__________________________ | ||
7.__________________________ | ||
8.__________________________ | ||
2. By initialing below, the patient or patient's | ||
personal or legal representative excludes the following | ||
information from this authorization: | ||
________ HIV/AIDS test results and/or treatment | ||
________ Drug/alcohol/substance abuse treatment | ||
________ Mental health records (mental health records | ||
do not include psychotherapy notes) | ||
________ Genetic information (including genetic test | ||
results) | ||
D. The persons or class of persons to whom the patient's | ||
health information and billing records will be disclosed or who | ||
will make use of said information are: | ||
1. Any and all physicians or health care providers | ||
providing care or treatment to __________ (patient); | ||
2. Any liability insurance entity providing liability | ||
insurance coverage or defense to any physician or health care | ||
provider to whom Notice of Health Care Claim has been given with | ||
regard to the care and treatment of __________ (patient); | ||
3. Any consulting or testifying experts employed by or | ||
on behalf of __________ (name of physician or health care provider | ||
to whom Notice of Health Care Claim has been given) with regard to | ||
the matter set out in the Notice of Health Care Claim accompanying | ||
this authorization; | ||
4. Any attorneys (including secretarial, clerical, | ||
experts, or paralegal staff) employed by or on behalf of __________ | ||
(name of physician or health care provider to whom Notice of Health | ||
Care Claim has been given) with regard to the matter set out in the | ||
Notice of Health Care Claim accompanying this authorization; | ||
5. Any trier of the law or facts relating to any suit | ||
filed seeking damages arising out of the medical care or treatment | ||
of __________ (patient). | ||
E. This authorization shall expire upon resolution of the | ||
claim asserted or at the conclusion of any litigation instituted in | ||
connection with the subject matter of the Notice of Health Care | ||
Claim accompanying this authorization, whichever occurs sooner. | ||
F. I understand that, without exception, I have the right to | ||
revoke this authorization at any time by giving notice in writing to | ||
the person or persons named in Section B above of my intent to | ||
revoke this authorization. I understand that prior actions taken | ||
in reliance on this authorization by a person that had permission to | ||
access my protected health information will not be affected. I | ||
further understand the consequence of any such revocation as set | ||
out in Section 74.052, Civil Practice and Remedies Code. | ||
G. I understand that the signing of this authorization is | ||
not a condition for continued treatment, payment, enrollment, or | ||
eligibility for health plan benefits. | ||
H. I understand that information used or disclosed pursuant | ||
to this authorization may be subject to redisclosure by the | ||
recipient and may no longer be protected by federal HIPAA privacy | ||
regulations. | ||
Name of Patient | ||
____________________ | ||
Signature of Patient/Personal or Legal Representative | ||
__________ | ||
Description of Personal or Legal Representative's Authority | ||
__________ | ||
Date | ||
_______________ | ||
SECTION 2. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2019. |