What is HIPAA Authorization to Release Medical Records?

HIPAA Authorization to Release Medical Records is a legal document that allows healthcare providers to share an individual's protected health information (PHI) with another individual, organization, or entity. This authorization ensures that patient privacy is maintained while also granting access to relevant medical records to those who require it.

What are the Types of HIPAA Authorization to Release Medical Records?

There are two main types of HIPAA Authorization to Release Medical Records:

General Authorization: This type of authorization grants healthcare providers the permission to share all of the patient's medical records for any purpose specified by the individual.
Specific Authorization: This type of authorization limits the sharing of medical records to a particular purpose or recipient, as specified by the individual.

How to Complete HIPAA Authorization to Release Medical Records

Completing a HIPAA Authorization to Release Medical Records requires the following steps:

01
Fill out the patient's personal information, such as their full name, date of birth, and contact information.
02
Specify the purpose of the release of medical records and provide details about the recipient or organization that will receive the information.
03
Indicate the duration of the authorization, whether it is a one-time release or if it remains valid until revoked by the patient.
04
Sign and date the authorization, and ensure that it is signed by the patient or their legal representative.
05
Keep a copy of the signed authorization for your records.

pdfFiller empowers users to create, edit, and share documents online. Offering unlimited fillable templates and powerful editing tools, pdfFiller is the only PDF editor users need to get their documents done.

Video Tutorial How to Fill Out hipaa authorization to release medical records

Thousands of positive reviews can’t be wrong

Read more or give pdfFiller a try to experience the benefits for yourself
5.0
Awesome PDF Tool for a low price It is a great tool that I would recommend to pe...
Awesome PDF Tool for a low price It is a great tool that I would recommend to people who are not very tech savvy. It is an easy to use tool with helpful features that can help any business that uses PDF documents on a frequent basis. It makes you pay for many features that can actually be found using free software alternatives if you do some research.
Ryan M.
5.0
PDF filler
Love it love it absolutely love it. I did I say I love it
michael
5.0
Needed to get a document signed asap, downloaded the app and within 5 mins i was...
Needed to get a document signed asap, downloaded the app and within 5 mins i was done and document sent ! seamless
Michael E.

Questions & answers

A HIPAA-compliant HIPAA release form must, at the very least, contain the following information: A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.
The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.
What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.
Authorization for release of information means the form prescribed by the agency for the purpose of authorizing the release of a confidential record, signed and dated by the person empowered to release the information.
An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the
A HIPAA authorization form, also known as a HIPAA release form, is a document that individual signs for their health provider before the entity may use or disclose their protected health information (PHI).