My thanks to attorney Chris Thompson, who prepared a 9-11-9.2 authorization. Here it is, and make sure you thank him if you use it:
MEDICAL AUTHORIZATION
PURSUANT TO O.C.G.A. * 9-11-9.2
COMES NOW Plaintiff in the above-styled action, and pursuant to O.C.G.A. * 9-11-9.2, files contemporaneously with the Complaint, the following Authorization:
I, [client] as Personal Representative of the Estate of [DECEASED], hereby authorize the attorney representing [PARTY] to obtain and disclose the protected health information contained in medical records of [PATIENT] to facilitate the investigation, evaluation, and defense of the claims and allegations set forth in the Complaint which pertain to [PATIENT]. This Authorization includes defense attorney*s right to discuss the care and treatment of PATIENT with all of PATIENT'S treating physicians, but only if the patient*s attorney, [NAME, ADDR, TEL] is present at these discussions. This Authorization does not provide for the release of protected health information that is considered privileged.
I request that you notify my attorney, [NAME] in the event you provide my protected health information to anyone. I further request that you notify my attorney of any request by defense counsel for you to meet with defense counsel to discuss PATIENT'S protected health information and further request that no meeting or any type of communication or discussion with defense counsel take place unless the patient*s attorney, is notified and present. Please be advised that I have signed this Authorization in a good faith effort to comply with O.C.G.A. * 9-11-9.2 but I DO NOT WAIVE my rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations. By signing this Authorization, I am not waiving and expressly reserve any and all objections I may have to O.C.G.A. * 9-11-9.2 to the extent this law is in violation of or pre-empted by HIPAA. See 45 C.F.R. * 160.203.
Defendant*s attorney is not permitted to use this Authorization and you are not permitted to disclose PATIENT'S protected health information to Defendant*s attorney, unless Defendant*s attorn ey requests for PATIENT'S protected health information complies with 45 C.F.R. * 164.512(e).
This Authorization shall expire six (6) months from the date of its execution.
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SIG BLOCK
