Indiana Code 16-39-2-5. Access to patient’s designee or legal representative; written request
(c) A patient’s written request for the release of the patient’s mental health record under this section must include the following:
(1) The name of the patient.
(2) The name of the person requested to release the patient’s mental health record.
(3) The name of the person, provider, or organization to whom the patient’s mental health record is to be released.
(4) The purpose of the release.
(5) A description of the information to be released from the mental health record.
(6) The signature of the patient.
(7) The date the request is signed.
(8) A statement that the patient’s consent to release of mental health records is subject to revocation at any time, except to the extent that action has been taken in reliance on the patient’s consent.
(9) The date, event, or condition on which the patient’s consent to release of mental health records will expire if not previously revoked.
(d) Unless otherwise specified in a written request under this section, a request for release of records is valid for one hundred eighty (180) days after the date the request is made.
(e) A request for release of records under this section may be revoked by the patient at any time, except to the extent that action has been taken in reliance on the consent.
(f) Mental health records requested by the patient to be released under this section may be released by the provider receiving the request, regardless of whether the patient is still receiving services from the provider.
[Pre-1993 Recodification Citation: 16-4-8-3.1(e).]
As added by P.L.2-1993, SEC.22. Amended by P.L.4-1997, SEC.5.