Get Oca 960

The OCA 960 form is a crucial document for the authorization of health information release under HIPAA regulations. This guide will provide you with step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to successfully fill out the OCA 960 form online.

1. Click the ‘Get Form’ button to obtain the OCA 960 form and open it in your selected online editor.
2. Enter the patient's name in the designated field, ensuring correct spelling and format.
3. Provide the date of birth for the patient in the appropriate section, using the format MM/DD/YYYY.
4. Input the Social Security Number in the designated field, noting that it should be formatted as XXX-XX-____.
5. Fill in the patient’s current address in the specified area to ensure proper communication.
6. Carefully read through the authorization statements provided in the first section of the form to understand your rights and protections under HIPAA.
7. In Item 8, identify the name and address of the individual or entity to whom the health information is being sent. This should include the New York State Office of Victim Services or any designated authority.
8. In Item 9(a), indicate the specific information you authorize to be released by initialing each relevant category, such as Alcohol/Drug Treatment or Mental Health Information.
9. If applicable, initial Item 9(b) to authorize discussion of health information with a designated attorney or governmental agency.
10. State the reason for the release of information in Item 10, indicating it is at the request of the individual for eligibility purposes.
11. If applicable, provide the name of the person signing the form if it is not the patient, along with their authority to sign on behalf of the patient.
12. Indicate the date or event upon which the authorization will expire, typically upon termination of eligibility for benefits.
13. Finally, ensure all fields are completed accurately, sign the form, and provide the date of signing before saving your changes.
14. Once completed, you can download, print, or share the form as necessary.

Start filling out your OCA 960 form online today to ensure your health information is handled with care.