Practitioners shall utilize a form, which may be in an electronic format, developed by the department for the certification required in subdivision (a) of this section. The practitioner shall submit to the department, the information required by subdivision (a) of this section, in a manner determined by the department, including by electronic transmission through a secure website. In the instance that a practitioner submits this information to the department electronically, the practitioner shall retain, for a period of five years, a printed copy of the electronic certification that shall contain the information required in subdivision (a) of this section.
The practitioner shall date and place his or her handwritten signature upon the printed certification, and provide the printed certification to the patient. The practitioner shall also maintain a copy of the signed certification in the patient's medical record.
N.Y. Comp. Codes R. & Regs. Tit. 10 § 1004.2