AUTHORIZATION
The New York City Health and Hospitals Corporation (HHC) is committed to protecting the privacy of our patients' medical information.
Patient information may be used and disclosed for purposes of treatment, payment, and healthcare operations. For other purposes, prior to disclosing a patient's information, the law requires the patient's written permission to share his or her medical information. To facilitate a request to disclose patient information, HHC has developed an authorization that complies with federal and state law. This form must be signed by the patient or the patient's personal representative before we can disclose the requested information.
Once fully completed, the HHC Authorization form should be forwarded to the Health Information Management Department at the appropriate facility.
Click below to view HHC's HIPAA compliant authorization:
- English
- Spanish
- Albanian
- Arabic
- Chinese
- French
- Haitian Creole
- Hindi
- Korean
- Polish
- Portuguese
- Russian
- Urdu
Click here to download the free Acrobat reader.
