HIPAA – Authorization for Defense Counsel Interview of Treating Physician

Jurisdiction: Country: United States | Province or State: New York

What is a HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel?

This form is a HIPAA-compliant authorization that you sign. It permits your treating health care providers to speak privately with defense counsel about your medical condition and care. It does not force any provider to speak. It gives permission under privacy rules, so a provider may choose to be interviewed. In most cases, the interview is outside a deposition and not under oath.

Who typically uses this form?

Plaintiffs sign it. Defense attorneys request it. Health care providers rely on it to confirm they may talk. Insurers for the defense use it to help assess risk. Courts in New York expect parties in personal injury and medical malpractice cases to address it during discovery.

You might need this form if you filed a lawsuit that places your medical condition in issue. The defense will want to evaluate your injuries and treatment. Medical records alone may not answer every question. Informal interviews can help defense counsel understand your history, causation, and prognosis. They may also confirm whether future care is necessary. The form authorizes those interviews within defined limits.

Typical usage scenarios

• A motor vehicle accident claim. You allege neck and back injuries. You sign the authorization so defense counsel can speak with your orthopedic surgeon or physical therapist.

• A premises liability case. You claim a shoulder tear from a fall. The defense seeks to interview your primary care physician about prior shoulder complaints.

• A medical malpractice case. You claim negligent surgery caused complications. The defense requests interview access to your later-treating providers to discuss your recovery and sequelae.

• A wrongful death case. The estate representative signs forms to allow interviews with the decedent’s treating providers regarding condition, treatment, and cause of death.

The form is specific to interviews. It is different from a record release. Many cases use both types of authorizations. A records release lets the defense obtain copies of your records. This interview authorization lets defense counsel ask providers questions. You can limit the scope to the injuries and time periods at issue. You can exclude sensitive categories unless you choose to include them.

You should know that the provider may decline an interview even with your authorization. The form makes the interview permissible, not mandatory. Defense counsel still must act within ethical and procedural rules. The form usually states that providers employed by a defendant should not be contacted using this authorization. That helps avoid conflicts and protects privileged communications.

When Would You Use a HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel?

You use this form during discovery in a New York personal injury or malpractice case. Defense counsel will ask for it after you place your medical condition in issue. Often, this occurs after you serve a bill of particulars and produce medical records. The defense reviews the records, identifies treating providers, and requests interview authorizations. If you refuse or limit authorization without good reason, the court may intervene. In practice, parties negotiate scope so the interviews address only relevant conditions.

If you are a plaintiff represented by counsel, your attorney will review and tailor the authorization. They will limit the time frame, conditions, and providers to the claims. They may exclude psychotherapy notes and other sensitive categories. They may set an expiration when litigation ends. They may also ask defense counsel to give advance notice of scheduled interviews. That allows you to inform your providers and avoid surprise.

If you are a self-represented plaintiff, expect defense counsel to send a proposed form. Read it carefully. Confirm that the providers listed are your treating providers. Confirm the scope matches the injuries at issue. Add an expiration and revocation clause if missing. Do not authorize disclosure by providers employed by named defendants. You may also exclude categories that require extra protections unless you decide they are necessary.

If you are defense counsel, you use the form to conduct efficient factual development. Interviews often clarify causation and prior conditions. Many providers prefer an informal call to a formal deposition. You still must respect the voluntary nature of the interview. You should send a copy of the signed authorization to the provider in advance. Offer to schedule at the provider’s convenience. Stick to medical facts within the authorized scope.

If you are a health care provider, you use the form to confirm your right to speak. You can agree to or decline an interview. If you agree, review the authorization first. Make sure it names you or your practice. Confirm the scope, time frame, and categories included. If the authorization excludes certain categories, do not discuss them. You can ask to have your risk manager or counsel present.

Estate representatives and guardians use this form when the patient cannot consent. A parent can sign for a minor. A guardian or agent with proper authority can sign for an incapacitated adult. An executor or administrator can sign for a deceased patient. Attach proof of your authority.

Legal Characteristics of the HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel

This is a legally effective HIPAA authorization when it contains the required elements and is properly signed. Without the authorization, providers generally may not discuss your protected health information with defense counsel. With it, they may disclose within the limits you set. The form should clearly describe the information to be discussed, who may disclose, who may receive, and the purpose. It should include an expiration and the right to revoke in writing. It should also warn that information disclosed may be redisclosed by the recipient.

Enforceability rests on compliance with privacy requirements and New York practice. A valid authorization removes the privacy barrier to an informal interview. It does not compel any provider to speak. It also does not waive privileges beyond your medical privacy rights. The form commonly states that the interview is voluntary and can end at any time. You can revoke the authorization at any time, except to the extent someone has already relied on it.

Certain categories of information have heightened protections. These can include substance use disorder treatment records, HIV-related information, mental health treatment information, reproductive health services, genetic testing information, and psychotherapy notes. Many New York forms require you to initial next to each category to include it. If you do not initial, the category remains excluded. Psychotherapy notes often need a separate authorization. Be cautious when including sensitive categories. Include them only if they are directly relevant to the claims.

The authorization should be specific to treating providers who are not employed by a defendant entity. It should not authorize communications with physicians who are agents of the defendant hospital or practice. Those communications can risk privileged and work-product information. The authorization should also bar questions about attorney-client communications or litigation strategy. Most standardized forms include these limitations.

Courts expect the scope of disclosure to match the conditions in controversy. A broad, unlimited disclosure can invite disputes. Reasonable limits include a date range, a list of providers, and conditions tied to the claims. If you and the defense cannot agree on scope, a court can set appropriate boundaries. The goal is to allow fair discovery while protecting privacy.

A signed copy is as effective as an original, and providers may rely on a copy. Notarization is not mandated by HIPAA. However, many New York providers prefer a notarized form. Some courts and counsel request notarization to avoid later challenges. You should use notarization if practical.

How to Fill Out a HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel

Follow these steps to complete the form correctly. Work line by line. Keep your scope narrow and relevant. If a section does not apply, mark it “N/A” rather than leaving it blank.

1) Identify the patient

• Enter your full legal name, including middle initial.
• Add your date of birth.
• Add your address and a reliable phone or email.
• If you use a different name in medical records, list that alias.

If you are signing for someone else, note the patient’s information and your role. Examples: parent of minor, court-appointed guardian, health care proxy agent, executor.

2) Name who may disclose information

• List each treating provider by name and practice group.
• Include full practice addresses and phone numbers if possible.
• You can add “and all medical staff working under their supervision.”

You may attach a schedule labeled “Schedule A – Treating Providers.” List hospitals, practices, and individual clinicians. Avoid naming providers employed by a defendant entity. If a large hospital system is involved, list the specific departments that treated you.

3) Name who may receive and conduct the interview

• Identify defense counsel by name and law firm.
• Include the insurer and authorized representatives as recipients.
• Add “agents, experts, nurses, and consultants retained by defense counsel.”

This prevents disputes when an investigator or nurse conducts the interview. You can allow recording only if you agree. If you do not want recording, state: “No audio or video recording without my written consent.”

4) State the purpose

Use clear, narrow language such as: “To permit defense counsel in the above-captioned case to conduct an informal, voluntary interview with my treating provider concerning the injuries, conditions, care, and prognosis placed in issue in this litigation.”

Avoid broad purposes like “for any lawful purpose.”

5) Define the scope of information

Be precise:

• Describe the relevant injuries and body parts. Example: “lumbar spine and right shoulder.”
• Limit to conditions placed in the issue. If you allege aggravation of a preexisting condition, include that condition and the relevant prior period.
• Exclude unrelated conditions. Example: “This authorization does not include gynecological, dermatological, or unrelated mental health treatment.”

Add a date range. Example: “From three years before the incident date through the present.” If prior records are relevant to causation, specify those years.

Clarify that this authorization is for interviews only. State: “This authorization does not authorize the release of written medical records. A separate records authorization addresses records.”

6) Address sensitive categories

Your form may list categories that require special consent. Initial only the ones you intend to include. If you leave a category un-initialed, it is excluded.

Common categories:

• HIV-related information
• Sexually transmitted disease information
• Mental health treatment information (not including psychotherapy notes)
• Psychotherapy notes (often require a separate authorization)
• Substance use disorder treatment records
• Reproductive health services
• Genetic testing information

If any listed category is directly relevant, initial it. If not, leave it blank. When in doubt, exclude. You can amend later if needed.

7) Set conditions for the interview

State the voluntary nature:

• “The interview is voluntary. My provider may decline or stop at any time.”

Limit participants and topics:

• “Plaintiff’s counsel need not attend. Defense counsel may not inquire about attorney-client communications or litigation strategy.”

Exclude defendant-employed providers:

• “This authorization does not permit interviews with providers employed by or acting for any defendant or its counsel.”

Control recordings and notice:

• “No recording absent my written consent.”
• You may add: “Defense counsel will provide at least five business days’ notice of any scheduled interview.”

These terms protect fairness and reduce later disputes.

8) Add expiration and revocation

Include both:

• Expiration: “This authorization expires at the earliest of final resolution of the litigation (including appeals) or one year from the date below.”
• Revocation: “I may revoke this authorization at any time by written notice to defense counsel and to the provider. Revocation does not affect disclosures already made in reliance on this authorization.”

An expiration keeps the scope reasonable. A revocation clause protects your control.

9) Include a redisclosure warning

Add standard language:

• “Information disclosed under this authorization may be redisclosed by the recipient and may no longer be protected by federal health privacy law.”

This satisfies a required notice and informs you of the risk.

10) Identify the case

List:

• Court, county, and index or docket number.
• Case caption (e.g., Your Name v. Defendant Name).
• Incident date.

Tie the authorization to the specific case. That prevents use outside the case.

11) Signatures and authority

Sign and date. Print your name under the signature. If you are signing for someone else, state your authority and attach proof:

• Minor: parent or legal guardian. Attach guardianship papers if applicable.
• Incapacitated adult: guardian or health care proxy agent. Attach an appointment or proxy.
• Deceased patient: executor or administrator. Attach letters testamentary or administration.

Include your contact information for provider confirmation.

12) Witness and notarization

HIPAA does not require a witness or notary. In New York, many providers prefer notarization. If possible:

• Sign in front of a notary.
• Use the notary acknowledgment that matches your role (individual or representative).
• The notary will complete the acknowledgment and affix a stamp.

If a notary is not available, use a witness signature line. Choose a disinterested adult.

13) Attach schedules

Attach:

• Schedule A: List of treating providers and contact information.
• Schedule B: List of excluded categories or topics, if you want to emphasize limits.
• Schedule C: Any case details helpful for context, such as the claim number.

Refer to each schedule in the body of the authorization.

14) Distribute and retain copies

• Keep the original with your records.
• Provide a copy to defense counsel.
• When defense counsel schedules an interview, they should send the authorization to the provider.
• You may also send a courtesy copy to the provider yourself with a short cover note.

Remind the provider that the interview is voluntary and limited to the authorization’s scope.

15) Common mistakes to avoid

• Overly broad scope. Do not authorize “any and all” information without limits.
• Missing expiration or revocation. Always include both.
• Failing to limit by provider. Name your treaters. Avoid blanket health system language unless necessary.
• Including psychotherapy notes inadvertently. Those require special handling. Exclude unless you intend to include.
• Authorizing defendant-employed providers. Exclude them from the text.
• No identification of the litigation. Always tie to the specific case.
• No signature authority proof. Attach your appointment if you sign as a representative.
• Leaving sensitive category boxes un-initialed but not expressly excluded. Use clear language to exclude non-initialed categories.

16) Practical example of a completed scope clause

“Scope: This authorization permits defense counsel for ABC Trucking Co. to conduct an informal interview with Dr. Jane Smith, Orthopedics NY, regarding evaluation and treatment of my lumbar spine and right shoulder injuries allegedly sustained in the January 10, 2024 collision, including prior lumbar spine conditions from January 10, 2021 forward. This authorization excludes gynecological care, dermatological care, mental health psychotherapy notes, reproductive health services, genetic testing information, and HIV-related information. Mental health treatment information unrelated to pain management is excluded.”

17) Practical example of a condition clause

“Conditions: The interview is voluntary and may be ended by the provider at any time. Plaintiff’s counsel is not required to attend. Defense counsel may not inquire into attorney-client communications or litigation strategy. No recording is permitted without my written consent. This authorization does not apply to providers employed by or acting on behalf of any defendant or its counsel.”

By following these steps, you keep the authorization clear and enforceable. You protect your privacy while allowing fair discovery. You also reduce motion practice over scope and form. The result is a cleaner, faster discovery process that focuses on the merits of your case.

Legal Terms You Might Encounter

• HIPAA. This federal privacy law protects your medical information. On this form, HIPAA sets the rules for what your treating physician can share. The authorization is your written permission to let disclosure happen outside normal privacy limits.
• Authorization. This is your signed permission. By signing, you let your treating physician speak with defense counsel. The authorization defines what can be shared, with whom, and for how long. Without it, your doctor generally cannot discuss your care.
• Protected Health Information (PHI). PHI includes details that identify you and relate to your health or care. A doctor’s notes, diagnoses, medications, and lab results are all PHI. This form tells your doctor which parts of your PHI can be discussed during the interview.
• Treating Physician. This is the doctor or provider who treated you for the issues in your case. It can include specialists, primary doctors, therapists, or hospitals. The form allows defense counsel to interview these providers about your care within set limits.
• Defense Counsel. This is the attorney for the opposing party. By signing, you let defense counsel interview your provider outside a deposition. The form does not make you waive all privacy. It only allows what you state in the authorization.
• Ex Parte Interview. This is a private interview without you or the court present. Defense counsel may ask medical questions within the scope of your authorization. This form is what permits your provider to take part in that interview.
• Scope of Disclosure. The scope describes what the provider may share. It can limit topics, date ranges, or conditions. You can restrict the interview to injuries and treatment at issue in your case. Clear scope language helps avoid over-sharing.
• Revocation. Revocation means you cancel your authorization. You can revoke at any time, in writing. After revocation, your provider should not participate in new interviews. Revocation does not undo disclosures already made under the prior authorization.
• Expiration. The form can include a time limit or an event that ends permission. For example, you can set an expiration date or tie it to the end of the case. If you do not set one, the form may last longer than you intend.
• Personal Representative. If you sign for someone else, you are the personal representative. You may be a parent, guardian, or agent under a valid document. The form should state your authority so the provider can rely on it.

FAQs

Do you have to sign this authorization?

No. You choose whether to sign. Consider what you are comfortable sharing. If you refuse, your case may still move forward. However, there may be case-related consequences. Discuss timing, scope, and alternatives with your counsel before you decide.

Do you control what defense counsel can ask your doctor?

Yes, through the scope limits in the authorization. You can limit dates, body parts, providers, or conditions. You can exclude sensitive categories if the form allows that. Your provider should follow your stated limits during the interview.

Do you need a separate authorization for medical records?

Often, yes. This form permits an interview. It may not authorize the release of documents. If records are needed, use a records-specific authorization. Keep interviews and records access scoped to what is relevant.

Do you get notice before the interview occurs?

It depends on case procedures and agreements. Some providers will not speak without scheduling through counsel. You can request that interviews be coordinated in advance. Put any notice preferences in writing and keep copies.

Do you need a notary or witness to make this form valid?

Check the signature section of the form. If it includes a notary block, you must complete it. Some providers also prefer notarized forms. When in doubt, sign before a notary to avoid delays in scheduling.

Do you have to include mental health, substance use, or other sensitive information?

No. You can often exclude sensitive categories. You can also limit it to the injury and treatment at issue. If you decide to include sensitive areas, make sure the form requires your initials. Initial next to each category you approve.

Do you receive a copy of the interview?

Not automatically. This is a private interview. You can request that any interview be noted in writing. You can also request that a copy of any written summary be shared, if one exists. Put requests through counsel and keep a record.

Do you lose all privacy protections by signing this form?

No. You only allow what the authorization covers. Your provider should not discuss anything beyond your stated limits. You can revoke later, but past disclosures remain in effect.

Checklist: Before, During, and After the HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel

Before signing

• Identify the providers you will authorize. Include full names, practices, and addresses.
• Confirm your case caption and index number match your court filings.
• Decide what topics the interview may cover. Limit to injuries and treatment at issue.
• Set date ranges for the permitted disclosure.
• Decide whether to include or exclude sensitive categories. These can include mental health, substance use, reproductive health, or HIV-related information. Plan where initials are required.
• Choose an expiration date or event, such as the end of the case.
• Gather your identification and any authority documents if you sign for someone else.
• Write down the exact name and contact details of defense counsel.
• Plan how you will deliver copies to providers and counsel. Consider a trackable method.
• Speak with your counsel about scheduling preferences and any ground rules.

During signing

• Verify your name, date of birth, and contact information.
• Check that the provider details are accurate and complete.
• Confirm the case caption, court, and index number are correct.
• Review the scope section. Add clear limits on topics, dates, or conditions.
• Mark each sensitive category. Initial next to any category you approve. Cross out those you exclude.
• Fill in the expiration date or event. Avoid open-ended authorizations.
• Review any redisclosure warnings so you understand the risk.
• Sign and date exactly where indicated. Print your name clearly.
• If you are a personal representative, state your relationship and authority.
• If the form includes a notary block, complete it with a valid ID.
• Make a complete copy before you hand over the original.

After signing

• Send a copy to defense counsel using a trackable method.
• Send a copy to each authorized provider with a short cover note. Include defense counsel’s contact details for scheduling.
• Keep a copy in your file. Note the date signed and the expiration.
• Tell your counsel which providers you authorized and any limits you set.
• Calendar the expiration date so you can renew or let it lapse.
• If you revoke later, send written notice to providers and defense counsel. Keep proof of delivery.
• Only file the form with the court if you are directed to do so. Otherwise, keep it in your records.

Common Mistakes to Avoid HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel

• Leaving the scope blank or too broad. Don’t forget to define dates, topics, and providers. A vague scope can lead to wider disclosures than you intend.
• Failing to initial sensitive categories. Many forms require your initials for sensitive topics. Without initials, providers may refuse to speak or may disclose more than you want.
• Omitting an expiration. An authorization with no end date can outlast your needs. Set a clear expiration tied to a date or case event.
• Using wrong or incomplete provider details. A missing address or name variation can delay scheduling. Confirm exact provider names and locations.
• Not documenting your authority as a representative. If you sign for someone else, attach proof of your authority. Without it, providers may reject the authorization.

What to Do After Filling Out the Form HIPAA – Authorization to Permit Interview of Treating Physician by Defense Counsel

1. Distribute copies promptly. Send a copy to defense counsel and to each authorized provider. Include accurate contact details for scheduling. Keep proof of delivery.
2. Coordinate logistics. Let your counsel know which providers you authorized. Share your scope limits and any sensitive exclusions. Discuss whether you want to receive notice before any interview.
3. Update your case file. Record the date signed, expiration, and the providers covered. Keep a copy of every version you sign. Use a simple log to track interviews scheduled or completed.
4. Monitor for changes. If your treatment changes, revisit your scope. You can amend by issuing a new authorization with updated limits. Mark the new version clearly and circulate it.
5. Revoke if needed. You can revoke in writing at any time. Send revocation to defense counsel and all affected providers. Keep dated copies and proof of delivery. Remember, revocation stops future disclosure, not past interviews.
6. Renew if the case continues. If your authorization expires before the case ends, decide whether to renew. Use a fresh expiration date and confirm the scope still fits your needs.
7. File only if directed. Unless a court directs filing, keep the form in your records. If you must file, use the caption and index number exactly as shown on your case papers.
8. Protect your privacy. Share only what is necessary for the case. Keep versions consistent and signed. Do not circulate drafts that contain sensitive changes.