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Sample HIPAA Authorization Form Form Template
HIPAA Authorization Form Basics

A HIPAA Authorization Form allows your doctor to release your medical records. Maybe you're being referred to another doctor, maybe you've moved to a different town, or maybe you're a doctor who needs access to your patient's prior records. A HIPAA Authorization Form lets you choose what information is disclosed and to whom.

Use the HIPAA Authorization Form document if:

  • You want your medical information released to a doctor.
  • You only want certain medical information sent to a MD.
  • You're a doctor and want to have the documents patients might need available.
  • You manage a medical office.

Sample HIPAA Authorization Form

More than just a template, our step-by-step interview process makes it easy to create a HIPAA Authorization Form.

Save, sign, print, and download your document when you are done.

If you've ever switched doctors or seen a specialist, you've probably had to sign a HIPAA Authorization Form. Your medical information is safe and protected by your doctor, and HIPAA laws, but maybe you need your records released. Maybe you're the MD and need access to a patient's old records. Getting that information can make a huge difference in how you treat your patient but first your patient needs to authorize it. Make it easy by providing them with the documents. A HIPAA Authorization Form helps protect patient privacy and helps doctors do their job.

Other names for this document: HIPAA Privacy Authorization Form, Health Insurance Portability and Accountability Act Authorization

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