HIPAA Release Form

Understand how a HIPAA Release Form works when disclosing confidential medical information. Download a free template and example here.

By Ericka Pingol on Apr 08, 2024.

Fact Checked by Ericka Pingol.

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What is a HIPAA Release Form?

The Health Insurance Portability and Accountability Act (HIPAA) is a comprehensive piece of US legislation enacted in 1996, governing the protection and confidentiality of sensitive patient health information. Designed to ensure that patients' medical details remain private and secure, HIPAA sets stringent guidelines on how healthcare providers, insurance companies, and other entities must handle patient data. These regulations encompass not only the release of information but also the storage, transmission, and disposal of health records.

A is a document patients can use to authorize the release of their confidential medical information. HIPAA requires healthcare providers to obtain written consent before releasing personal health information.

This document allows individuals to specify what details may be disclosed and who can view them. It is also used to authorize the release of protected health information (PHI) covered under HIPAA regulations. This includes personally identifiable information such as medical records, lab results, bills, and demographic data like names, addresses, and Social Security numbers.

Printable HIPAA Release Form

Download this HIPAA Release Form to ensure you maintain compliance when releasing PHI.

How does it work?

We have designed a pre-made printable HIPAA Release Form template to help you and your patients quickly and easily create a legally binding document. Follow these steps to get started:

Step One: Access the free template

Download our HIPAA Release Form using the link on this page. You can also get a copy from the Carepatron app or our resources library.

Step Two: Explain the form to your patient

Explain to your patient that they are authorizing you to disclose their protected health information. Ensure they understand how the form works and what rights they have regarding their data.

Step Three: Fill in the blanks

Fill in all the required details on the form, such as your practice's name, address, and contact information. Then ask your patient to complete the form by writing the purpose of the release of information, the specific information to be released, and the duration of their authorization.

Step Four: Sign the form

Both you and your patient must sign the form for it to be legally binding. Make sure all signatures are witnessed by a third party if necessary, as required by HIPAA guidelines.

HIPAA Release Form example (sample)

We created a HIPAA Release Form PDF example illustrating how our free template works. This sample shows how to fill up a HIPAA Release Form that can be used as a legally binding document. You may view the sample here or download it as PDF for reference.

Download the free HIPAA Release Form example (sample)

HIPAA Release Form example (sample)

When would you use this Template?

You can use this template to help your patients authorize the release of their PHI to themselves or third parties, such as insurance companies, attorneys, or other healthcare providers. This is especially important when sharing medical records with outside organizations not covered by HIPAA regulations.

 Additionally, you can use this form to:

Obtain prior consent from patients before releasing medical information

You can utilize this HIPAA Release Form to obtain written consent from patients before disclosing their personal health information. This helps protect you and your patient in the event of a legal dispute over who is responsible for data breaches or unauthorized access.

Demonstrate compliance with HIPAA regulations

The form also serves as evidence of compliance with HIPAA guidelines, which require healthcare providers to keep all PHI secure and confidential. Having a signed HIPAA Release Form on file is an important step in ensuring you adhere to these regulations. 

Document the authorization of a patient’s confidential data

A HIPAA Release Form provides documentation of authorization for the release of confidential data, which is required by HIPAA regulations. This helps protect you from potential legal action if someone disputes your decision to share PHI with an outside organization or individual.

Protect your practice from any legal repercussions or privacy violations

Using this template helps protect your practice from potential legal repercussions or privacy violations resulting from the unauthorized release of confidential patient information. This is especially important for practices that regularly handle large amounts of PHI.

Who can use this free HIPAA Release Form PDF?

This free template is designed for use by healthcare providers, such as:

  • Doctors
  • Nurses
  • Dentists
  • Mental health professionals
  • Physical therapists
  • Counselors
  • Other professionals in the healthcare field

It can also be used by hospitals or other organizations handling PHI to ensure compliance with HIPAA regulations. Additionally, insurance companies, attorneys, and third-party entities may benefit from its use when requesting access to confidential medical information.

Electronic Health Records Software Feedback

Why use Carepatron as your HIPAA Release Form app?

Don't let paperwork steal precious moments from your patients! Empower your healthcare practice with Carepatron, the all-in-one practice management software designed to streamline your day, enhance patient outcomes, and skyrocket your practice to new heights.

Our intuitive and user-friendly solution organizes all patient data, simplifies documentation, accelerates billing processes, and more –seamlessly integrated into one reliable system. Carepatron makes it easier to provide quality care in today’s complex healthcare environment.

With Carepatron, you can:

  • Automatically update patient information in real-time
  • Create pre-built templates for documentation to save time
  • Easily generate helpful reports and analytics
  • Streamline the billing process with integrated payment processing
  • Track all lab results, medications, and clinical notes in one place
  • Enable secure patient communication with two-way messaging

Plus, our dedicated customer service team is available to answer any questions you have and ensure that your practice can take advantage of all the features Carepatron has to offer.

For healthcare professionals who are ready to take their practice to the next level, Carepatron is the perfect solution. Join thousands of other successful practices and start streamlining your workflow today!

Electronic Health Records Software
Who uses HIPAA Release Forms?
Who uses HIPAA Release Forms?

Commonly asked questions

Who uses HIPAA Release Forms?

HIPAA Release Forms are used by healthcare providers, insurance companies, attorneys, and other third-party organizations to obtain written consent for the release of patient confidential health information. These forms are required to ensure that data is protected and stored securely, as outlined by HIPAA regulations.

When do you use HIPAA Release Forms?

HIPAA Release Forms are used whenever confidential patient medical information needs to be shared with an outside entity. This includes when patients want to access their records or when a healthcare provider shares information with another organization, such as an insurance company or attorney.

How do you store completed HIPAA Release Forms?

HIPAA Release Forms should be kept securely in an electronic or paper record system. If stored electronically, the records must be encrypted and password-protected to ensure the secure storage and transmission of PHI. Paper forms should be locked away in a safe location, such as a filing cabinet.

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