Authorize release of your records to another provider or organization
Authorization for Release of Information
A signed authorization lets EKM Psychiatry release your medical records to another provider, organization, or individual. Please read the information below before contacting us.
What is a Release of Information?
A Release of Information (ROI) is a legally required authorization that allows EKM Psychiatry to share your medical records with a third party. Under HIPAA and New York State law, we cannot release any portion of your records without your written consent.
Common reasons for requesting a release include transferring care to a new provider, supporting a disability or insurance claim, providing records for legal proceedings, or sharing documentation with a school or employer.
New York State law requires separate written authorization for mental health records, substance use treatment records, and reproductive health information. Each of these categories must be authorized individually on the form. Releases are processed within 5–10 business days of a complete and verified authorization.
Types of records
You may authorize the release of any of the following types of records held by EKM Psychiatry:
Clinical records
- Progress notes and treatment records
- Psychiatric evaluations and assessments
- Diagnoses and treatment summaries
- Medication records and prescriptions
- Dates of service only
- Entire medical record
NY State protected categories
- Mental health treatment records
- Alcohol or substance use disorder treatment
- Reproductive health services
These categories require specific written authorization under NY law and must be authorized individually.
Your rights
You have the right to
- Revoke this authorization at any time in writing
- Limit the scope of what is released
- Set an expiration date on this authorization
- Receive a copy of your signed authorization
- Refuse to sign without affecting your treatment
Important limitations
- Revocation does not apply to actions already taken
- Released records may be re-disclosed by the recipient
- Treatment is not conditioned on signing an authorization
- A signed authorization is required before any records are transmitted
How it works
- Send your requestComplete and sign the authorization form below, including who the records should go to and any NY State protected categories you are authorizing. Prefer paper? Call or send us a secure message and we will send you the form.
- Administrative reviewOur team will review your authorization within 2–3 business days to verify your identity and confirm the authorization is complete and valid.
- Records preparationYour provider will review and prepare the requested records. Standard processing time is 5–10 business days from confirmed submission.
- DeliveryRecords will be sent directly to the recipient you specified by secure fax, encrypted email, or mail, depending on the information provided.
Prefer to talk to us? Call (518) 703-6840.