HIPAA Authorization Form for Secure Medical Information Release

A HIPAA Authorization Form is a legal document that allows healthcare providers to release a patient's protected health information (PHI) to a third party. This form is necessary for compliance with the Health Insurance Portability and Accountability Act (HIPAA) privacy rule, which protects the privacy of patients' health information. By signing this form, patients give their explicit consent for their healthcare provider to disclose their PHI to a specified third party, such as a family member, caregiver, or insurance company. This form include certain elements, such as the purpose of the disclosure, the specific information to be disclosed, and the date of the authorization.

Unlimited submissions

Clean design

Detailed documentation

Book Demo
HIPAA Authorization Form

Unparalleled features creating true impact

No items found.

Complex schedules made easy

Run group and recurring bookings, ad-hoc appointments, and more.

Private and group chats

Support patients with on and offline chat messaging and file sharing.

Video calls from anywhere

Crisp and secure video appointments from any device.

Medical form builder

Free up front desk with digital forms completed online prior to visit.

Remote patient monitoring

Assess health indicators virtually using mobile & web cameras.

Custom notifications for all

Set dynamic email and SMS notifications for patient and staff.

Customizable booking page

Create your booking page, embed it into your site or share a link.

Patient management portal

For patients to manage sessions, prescriptions and more.

Related templates

Up the Ante with Upvio