Authorization for Release and Complaint Forms

On December 14, 2016, the New York State Department of Health initiated a 45 day public comment period on proposed amendments to state regulations regarding HIV/AIDS Testing, Reporting and Confidentiality of HIV-Related Information. The public comment period will end on January 30, 2017. Updated information will be posted to this site after the DOH has completed its review and deliberations on comments received. To view the proposed amendments and for directions on how to submit comments, please visit:

Authorization for Release of Health Information and Confidential HIV Related Information

Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS Related Information

This form, DOH-5032, was created to facilitate sharing of substance use, mental health and HIV/AIDS information. This form is somewhat like the "Authorization for Release of Medical Information and Confidential HIV Related Information" (DOH-2557), but would fulfill a need to share information within facilities in which different teams handle substance use, mental health and HIV/AIDS-related issues. In addition, the DOH-5032 would fulfill a need to share information between facilities and providers that care for the same patient. Like the DOH-2557, the DOH-5032 is intended to encourage multiple providers to discuss a single individual's care among and between themselves to facilitate coordinated and comprehensive treatment. Although the new form (DOH-5032) may be used in place of DOH-2557, it is not intended to replace any forms currently available.

Complaint Report for Alleged Violation of Article 27F