Download HIPAA Authorization Form

The HIPAA Privacy Authorization Form authorizes your health insurance company to disclose/use your Protected Health Information or medical records. In HIPAA Authorization Form you authorize your company in this manner:

I authorize ________________________________________ (healthcare provider) to use
and disclose the protected health information described below to
______________________________________________ (individual seeking the information).

You can authorize your company for a particular period, or for all past, present, and future periods.

Download HIPAA Authorization Form

Download HIPAA-Authorization-Form-pdf.pdf (70KB)

Leave a Reply