N.Y. Comp. Codes R. & Regs. tit. 18, § 405.3
(d) Model formats for local purchase of services contract developed by the department shall be used by the social services district. They may be modified, as necessary, to cover additional details or to reflect in greater detail the specifications and terms under which payment will be made for services rendered. They shall be prepared in accordance with instructions promulgated by the department.
(e) Contract period.
(g) The written contract shall:
(16) include the requirement that any disclosure of confidential HIV-related information must be accompanied by a written statement as follows:
“This information has been disclosed to you from confidential records which are protected by State law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of State law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is not sufficient authorization for further disclosure.”;