Nassau County Office of Housing Community Development Survey
December 30, 2019
What are Medicaid Liens?
January 1, 20201. Fill out the enclosed HIPAA release form for each one of your doctors’ offices and hospitals where you received treatment for the condition or injury that keeps you from working. Make sure you fill in all the highlighted sections on this HIPAA release. Be sure to include the name of the Magistrate assigned to your case.
2. For each doctor’s office/hospital, you will need to hand them the “Instructions For Treatment Provider” form. Fill in your name and date of birth on each of these forms. You will also need to hand them the “Business Record Certification” Form. (The doctor’s office/hospital will fill this form out themselves.)
3. Go in-person to the doctor’s office or hospital and hand them all of these completed forms, with the “Instructions for Treatment Provider” on top. Ask them not to charge you for these records. Explain how little you income you receive each month and that you can’t afford to pay their usual copying fee. (We can’t promise they will not charge you, anyway, for these records.) Make a note of the date you dropped off these forms.
4. When you appear at your Family Court hearing, tell the Magistrate you had requested certified medical records from your doctors and the date you requested them. Ask the Magistrate if they were delivered to the court.
