A HIPAA release form is a document that – when signed – allows healthcare providers to share a patient’s protected health information (PHI) with specified individuals or organizations, …

I, ____________________________________hereby voluntarily authorize the disclosure of information from my health record. (Name of Patient) This information is to be released for the …

Aug 11, 2025 · This HIPAA release form was created as a standard official form to be used to authorize the release of health information needed for litigation in New York State courts.

Jul 31, 2025 · Download a free HIPAA medical records release form to authorize the sharing of your health information. Available in PDF and Word.

The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C. 552a; and 38 U.S.C. 5701 and …

Health Information Management (HIM) department contact information: ... Instructions for completing authorization: OF RELEASE PROTECTED HEALTH INFORMATION" form. …

Aug 1, 2025 · Follow these steps to get started: Step 1: Access the form. You can download our Blank Authorization to Release Information Form from the link provided on this page. …

By signing this form, I acknowledge and consent to the release of my health information, which may include sensitive information such as records related to alcohol or drug use, mental health …

authorize the release of information including the diagnosis, records, examination results, medication dose changes, and claims information. This information may be released to: - …

Nov 6, 2024 · The medical record information release (HIPAA) form allows patients to give authorization to a 3rd party and access their health records. It also allows the added option for …