Ind. Code § 12-24-11-2
(d) If a patient agrees to release the records, the patient shall sign a form permitting the state institution to release to a service coordinator employed by the division of disability and rehabilitative services under IC 12-11-2.1 a copy of the patient's medical and treatment records to forward to local agencies serving the needs of individuals with a developmental disability in the area in which the patient will reside. The form must read substantially as follows:
AUTHORIZATION TO RELEASE
MEDICAL AND TREATMENT
RECORDS
I agree to permit ________________________________
(name of state institution)
to release a copy of the medical and treatment records of
__________________ to _________________________
(patient's name) (name of local agency
serving the needs of
individuals with a developmental disability)
______________ ___________________________
(date) (signature)
___________________________
(address)
____________________ ___________________________
(signature of individual (relationship to patient if
securing release of signature is not that of the
medical and treatment patient)
records)
(e) If a patient knowingly signs the form for the release of medical records under subsection (d), a service coordinator employed by the division of disability and rehabilitative services under IC 12-11-2.1 shall allow local agencies serving the needs of individuals with a developmental disability in the area in which the patient will reside to obtain the following:
(g) If a patient does not agree to permit the release of the patient's medical and treatment records, the service coordinator shall deliver:
(2) the address of the patient's intended residence;
to local agencies serving the needs of individuals with a developmental disability in the area in which the patient will reside before or at the time the patient is discharged.
[Pre-1992 Revision Citation: 16-14-28-1(b).]
As added by P.L.2-1992, SEC.18. Amended by P.L.4-1993, SEC.200; P.L.5-1993, SEC.213; P.L.24-1997, SEC.55; P.L.272-1999, SEC.45; P.L.141-2006, SEC.65; P.L.99-2007, SEC.117.