Free HIPAA Authorization To Disclose Protected Health Information

A HIPAA Authorization To Disclose Protected Health Information, or HIPAA Release, is a document signed by a patient which enlists all individuals they wish to have access to their sensitive medical records.

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When a patient goes to a health facility for a procedure, they need to know their medical information won't be available to anyone who asks for it. Health information contains a record of past illnesses, medications a patient was or is taking, and insurance bills. Even your spouse or close family members aren't allowed to access your private medical information if they aren't listed on a HIPAA Release.

What Is a HIPAA Release?

A HIPAA Authorization To Disclose Protected Health Information, also known as a HIPAA Release, is a legal document providing healthcare workers with the ability to disclose a patient's private medical information to other specified third-parties. In other words, civilians who aren't authorized can't access this confidential document.

Parties sign a HIPAA Release when they go to a new medical facility. Their medical information must remain private, and disclosing it to unauthorized individuals is considered a violation. In most cases, parties can't sue healthcare providers if they give their records to unauthorized persons. They can only lodge a written complaint, which will be further investigated.

It's important to note that a HIPAA Release isn't mandatory. Moreover, a patient can revoke an authorization at any moment.

Other Names for a HIPAA Release

Depending on your state, a HIPAA Release may also be known as:

  • Medical Records Release Authorization

  • HIPAA Authorization To Disclose Protected Health Information

Who Needs a HIPAA Release

Since signing a HIPAA Release isn't required by law, parties can choose whether they want to do it or not. However, this means none of the close family members or friends can be informed about their medical condition while undergoing a procedure. A party may be in surgery or incapacitated, so health specialists might have to talk to someone about their situation.

For that, the best option would be for every individual to get a HIPAA Release. By signing this document, they make sure a doctor updates an authorized individual about the state of their health.

Finally, a patient is legally allowed to revoke a HIPAA Release and grant access to other individuals' medical information.

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How to Create a HIPAA Release with 360 Legal Forms

Creating this critical document is relatively easy, with 360 Legal Forms. All you have to do is select a HIPAA Release from our website, fill it in with necessary information, and we'll make a document that follows the laws of your jurisdiction. You can then download it as a PDF or a Word document.

What Information Will I Need to Create My HIPAA Release

To create your document, please provide:

  • Personal Information: Your full name, address, phone number, and date of birth.

  • Representative Information: If a patient can't sign a form for themselves, please provide the full name, address, phone number, and date of birth of a representative.

  • Releasing Party: The full name of a party who will have access to a patient's personal medical information.

  • Releasing Information: State if the releasing party will be granted access to all medical sources or just the named ones.

  • The Extent of Authorization: You can choose to limit releasing your private medical information in the following ways:

    • Types of Protected Medical Information: A patient can decide which type of medical information they want to exclude.

    • Time Frame: A patient can decide on a period they want to authorize an individual to have access to their medical records.

    • Electronic Disclosure: A patient can allow the information to be shared electronically.

    • Expiration Date: A patient can choose a date when the authorization expires.

HIPAA Release Terms

  • Releasing Party: A third-party who is granted access to a patient's sensitive medical information.

  • Authorization: A written permission by a patient allowing a medical specialist to disclose medical information to a third-party.

  • HIPAA: Health Insurance Portability and Accountability Act is a law that will enable an individual to choose parties who will be granted access to their otherwise confidential medical information.

HIPAA Release Signing Requirements

For a HIPAA Release to be legal, both the patient and the selected third-party must sign it. A witness doesn't have to be present. However, having one present can help prove a document is legal if anything should happen in the future. Furthermore, although notarizing the document isn't mandatory, doing so will protect all parties and ensure its effectiveness.

What to Do with Your HIPAA Release

Each party signing a HIPAA Release should get a copy of it.

Frequently Asked Questions

Yes. A patient can revoke their HIPAA Release at any time for whatever reasons. They may fall out with the selected individual or divorce a spouse. In that case, signing a new HIPAA Release is the best option. Furthermore, a patient can authorize multiple people to have access to their medical records. This all depends on the individual signing a HIPAA Release.

Health specialists can communicate and share a patient’s medical information with a Releasing Party using different means of communication. However, confidentiality still must be in place. Therefore, doctors should use safeguards when using emails for communication.
That said, email communication isn’t prohibited, as long as correspondents take necessary precautions.

Although a patient might not have granted authorization to different doctors, they can still have access to a patient’s medical information. Sometimes, various specialists must be informed about a patient’s condition to provide them with the best care possible. Therefore, it’s essential they’re familiar with a patient’s medical information. As long as that’s in the patient’s best interest, disclosing information to other doctors isn’t prohibited.

Many patients think that if doctors call them out by their name in a waiting room, they’re violating HIPAA. In reality, things are somewhat different. HIPAA allows this kind of information release. There are some instances when a doctor should pay more attention to protect a patient’s confidentiality. This is the case when patients are in a fertility section, psychiatry, etc.

A patient may decide when they want their HIPAA Release to expire. However, if a patient dies, this document will stop being valid within a year. Furthermore, a patient can choose to revoke their HIPAA Release before the expiration date. But they must do so in writing.