HIPAA Authorization for Disclosure of Medical Information (USA)

Prepare an Authorization for Disclosure of Medical Information with this USA form, in accordance with HIPAA requirements. HIPAA (the Health Insurance Portability and Accountability Act) protects your privacy by requiring you to give written authorization to a medical facility or health care provider before they can release your medical information and records to another person that you have designated as your personal representative. This could mean your spouse, adult children, and anyone that you have named as your health care agent / proxy under a power of attorney or advance health care directive. This USA HIPAA Authorization for Disclosure of Medical Information is provided in MS Word format and is easy to download, fill in and print.