1. (1) As used in this section:

   1. (a) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended.
   2. (b) "Patient" means the individual whose information is being requested.
   3. (c) "Personal representative" means an individual described in 45 C.F.R. Sec. 164.502(g).

2. (2) Before December 31, 2022, the department shall create a standard form that:

   1. (a) is compliant with HIPAA and 42 C.F.R. Part 2; and

   2. (b) a patient or a patient's personal representative may use to request that a copy of the patient's health records be sent to any of the following:

      1. (i) the patient;
      2. (ii) the patient's personal representative;
      3. (iii) the patient's attorney; or
      4. (iv) a third party authorized by the patient.

3. (3) The form described in Subsection (2) shall include fields for:

   1. (a) the patient's name;
   2. (b) the patient's date of birth;
   3. (c) the patient's phone number;
   4. (d) the patient's address;

   5. (e)

      1. (i) the patient's signature and date of signature, which may not require notarization; or
      2. (ii) the signature of the patient's personal representative and date of signature, which may not require notarization;
   6. (f) the name, address, and phone number of the person to which the information will be disclosed;
   7. (g) the records requested, including whether the patient is requesting paper or electronic records;
   8. (h) the duration of time the authorization is valid; and
   9. (i) the dates of service requested.

4. (4) The form described in Subsection (2) shall include the following options for the field described in Subsection (3)(g):

   1. (a) history and physical examination records;
   2. (b) treatment plans;
   3. (c) emergency room records;
   4. (d) radiology and lab reports;
   5. (e) operative reports;
   6. (f) pathology reports;
   7. (g) consultations;
   8. (h) discharge summary;
   9. (i) outpatient clinic records and progress notes;
   10. (j) behavioral health evaluation;
   11. (k) behavioral health discharge summary;
   12. (l) mental health therapy records;
   13. (m) financial information including an itemized billing statement;
   14. (n) health insurance claim form;
   15. (o) billing form; and
   16. (p) other.

Renumbered and Amended by Chapter 306, 2023 General Session