HIPPA Privacy Authorization Form

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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.

HIPPA Privacy Authorization Form
HIPPA Privacy Authorization Form

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.

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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.

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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.

WORD – HIPPA Privacy Authorization Form

PDF (fill-in-the-blanks) – HIPPA Privacy Authorization Form

We must include the following legal disclaimers:

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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.

As a user of this website, you assume all responsibility and risk for the use of the HIPPA Release of Medical Records Form or any legal form obtained from the site.

We do not assume any legal responsibility or liability for the accuracy or usefulness of the legal forms generated by the templates we offer.

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We will not be liable for damages or compensation, whether direct, indirect, or incidental, resulting from the loss of use or profit arising out of or in connection with the use or execution of the legal forms or the form templates.

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