OMH Forms

Health Insurance Portability and Accountability Act (HIPAA)

• Authorization for Patient Interview – OMH – 445
• Authorization for Patient Photograph – OMH – 446
• Notice of Privacy Practices - Standard
• OMH Sample Agreement – QA – 530
• Standard Authorization Form – OMH – 11 (English | اردو | 中文 | PyCCКИЙ | Español | Kreyòl Ayisyen)
• OMH Form 11C - Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS-related Information
• Status of OMH as Covered Entity

Licensing

• Request for Apartment Addition or Deletion and Waivers

MHL, CL, and CPL Commitment and Examinations Forms

• Full Listing of Commitment and Examinations Forms

Regulations

• Part 501 of Title 14 NYCRR grants the Commissioner the ability to waive regulatory requirements for purposes of testing innovative programs that may increase the efficiency and effectiveness of operations or providing additional flexibility to better meet local service needs while maintaining program quality and integrity.
  Instructions | Waiver Request Form