Your office also has a right, by New Jersey statute, to charge a reasonable amount for record copying. According to statutory language, the charge can be “no greater than $1.00 per page or $100.00, whichever is less.”[1] If the record is less than 10 pages, you may charge up to $10.00 to cover your costs; and if you are writing a summary, you may not charge any more than the record itself would have cost (according to these rules). If the requestor is asking for copies of items that cannot be duplicated in a regular copy machine (such as x-rays), you may pass on what you were charged for obtaining the copies. You may add an administrative fee of $10.00 or 10 percent of the cost of reproducing the items (whichever is less). This charge for special items may not be more than the fee for the rest of the copying.[2] Princeton Insurance provided an example Authorization Form in the Physician Practice Toolkit. This form has recently been updated and can be found in the Confidentiality of Patient Information section of the toolkit, located on the secure Princeton website.   Whether using the Princeton example form, a document the office has developed for itself, or just trying to interpret a lengthy attorney release, office staff should be aware of what information is necessary in a HIPAA-compliant authorization. An authorization is comprised of three groups of information: data (names, dates, times), authorization specifics, and patient rights information. Following is a checklist utilizing these group headings. You can use this checklist to quickly review any type of written request: Data ¨      Patient Name ¨      Previous Name of Patient ¨      Date of Birth ¨      Patient Signature ¨      Legal Representative’s Signature ¨      Relationship of Legal Representative to Patient ¨      Printed Name of Signatory ¨      Signature Date and Time Authorization Specifics ¨      Release Authorized for: o        All records o        Healthcare  information related to the following treatment or condition:__________ o        Healthcare information from [date] to [date] o        Other information (x-rays, billing, etc.) specified here:_________ o        Date range for other information requested: [date] to [date] ¨      Specific Release Granted For: o        HIV (AIDS virus) information o        Psychiatric disorders/mental health issues o        Sexually transmitted diseases o        Drug/alcohol use and/or treatment ¨      Release Records To (Information must be specific) ¨      Reason for Authorization o        Patient’s request o        Other (be specific) ¨      Authorization Ends o        On (specific date) o        At the occurrence of a specific event/s (specify) o        In 90 days from date of signature Description of Patient Rights ¨      Do Not Have to Sign to Get Treatment or Benefits ¨      Do Have to Sign if: o        Taking part in a research study o        Receiving care for the purpose of creating health information for a third party ¨      Have the Right to Revoke This Authorization o        Would need to fill out a revocation form, or o        Would need to write a letter to the practice, requesting revocation ¨      Revocation May Not Be Possible if Authorization Was for the Purpose of Obtaining Insurance ¨      Healthcare Information Released by Authorization is No Longer Protected by Privacy Laws Maintaining a good relationship with your patients and their families is important to your practice. Record requests can be uncomfortable for both the patient and the staff. Understanding your patients’ and your rights and responsibilities will help preserve the goodwill that you and your staff have worked so hard to achieve. [1] New Jersey Office of the Attorney General, Division of Consumer Affairs, State Board of Medical Examiners, Statutes and Regulations, http://www.state.nj.us/lps/ca/bme/bmelaws.pdf, April 2006, page 182-183. [2] Ibid.