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Webb1 juli 2024 · The range is $100 to $50,000 per violation, though the annual cap is $25,000. (This odd setup is because a 2024 change reduced the cap without changing the "per … WebbAuthorization for Release of Health Information (Including Alcohol/Drug Treatment NEW YORK STATE DEPARTMENT OF HEALTH and Mental Health Information) and Confidential HIV/AIDSrelated Information Patient Name Date of … WebbWhen filling out a HIPAA authorization form, include the following: The patient’s name, date of birth, address, and phone number; The name and contact information of the hospital or doctor who currently holds the patient’s medical records; The name and contact information of the person or entity who will receive the medical records; alissa turner mooresville indiana