The HIPPA Privacy Authorization Form is used to receive a copy of your medical record(s) or to have them sent to another party. The form is commonly used when switching doctors or health care providers. Under the strict guidelines of the HIPPA law, health care providers can’t share your medical information with any third party including your parents, children, or even your spouse.
The HIPPA Privacy Authorization Form requests that a health care provider share specific health information with another person or group. You might want your medical records sent to another doctor, hospital, or health care provider. The health information could be records from your medical file, rehab treatment, psychiatric visits, or anything similar.
We offer the free HIPPA Privacy Authorization Form in PDF format only. We were unable to convert the form to Microsoft Word due to unusual formatting on the PDF. The PDF version is chosen most often by users who want to print the document and fill in the blanks.
Click the link below to download the HIPPA Privacy Authorization Form in Microsoft Word format . You may also create the HIPPA Medical Records Release using our free fillable PDF version. The PDF has fillable fields into which you can type the required information.
Some states provide their own HIPPA medical records release form but you are not required to use the state form. The form below is HIPPA-compliant.
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The HIPPA Release of Medical Records Form and other legal forms available on this website are provided “as is” without any express or implied warranties of any kind including, but not limited to, warranty of merchantability or fitness for any particular purpose.
It is your responsibility to determine if the HIPPA Privacy Authorization Form is legally adequate for your needs.
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