45:14B-36 Valid authorization.
6. A valid authorization for the purpose of P.L.1985, c.256 (C.45:14B-30 et seq.) shall:
a. Be in writing;
b. Specify the nature of the information to be disclosed, the person authorized to disclose the information, to whom the information may be disclosed, the specific purposes for which the information may be used, both at the time of disclosure and at any time in the future;
c. Specify that the patient is aware of the statutory privilege accorded by section 28 of P.L.1966, c.282 (C.45:14B-28) to confidential communications between a patient and a licensed psychologist;
d. State that the consent is subject to revocation at any time;
e. Be signed by the patient or the person authorizing the disclosure. If the patient is adjudicated incapacitated or is deceased, the authorization shall be signed by the patient's legally authorized representative. When the patient is more than 14 years of age but has not yet reached majority, the authorization shall be signed by the patient and by the patient's parent or legal guardian. When the patient is less than 14 years of age, the authorization shall be signed only by the patient's parent or legal guardian; and
f. Contain the date upon which the authorization was signed.
L.1985, c.256, s.6; amended 2013, c.103, s.125.