Free HIPAA Release

Prepare a HIPAA release that names who may receive your medical records, with every element federal law requires and your state's rules for sensitive records.

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Your State and Your Name

Select your state. The authorization follows the federal rule everywhere and carries your state's rules for sensitive records.

Your State*

First Name*

Middle Name

Last Name*

Email Address*

Street Address*

City*

State*

ZIP Code*

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SELF-HELP SERVICE: SimplyTrust provides a self-help document preparation service. We are not a law firm and cannot provide legal advice, select forms for you, or tell you how to complete forms. Our role is limited to providing a platform where you input your own information into document templates.

NOT LEGAL ADVICE: This document was created entirely based on your selections. SimplyTrust does not review, analyze, or verify your entries, nor do we verify your identity, capacity, or authority to act. You are solely responsible for determining whether this document meets your needs and for completing all required execution formalities (signatures, witnesses, notarization, or recording) in accordance with your state's laws. For any legal questions, consult a licensed attorney in your state.

The written authorization the federal privacy rule requires before a provider or health plan may disclose your protected health information to someone you choose. A medical records release, an authorization to release health information and a HIPAA authorization are the same document. Federal law fixes its elements: what is released, to whom, for what purpose, when it ends, your signature and the date, and how you revoke it.

Anyone who wants a spouse, an adult child, a parent or a friend to be able to talk to their doctors and obtain their records. The authorization names the people and what they may receive, so the provider is not left to decide.

No. A healthcare power of attorney names someone to make medical decisions for you; a HIPAA release names who may receive your records and makes no one a decision-maker. The healthcare power of attorney prepared on this site appends this same authorization for the agent; the standalone release is for the people who are not your agent, or for anyone who wants the authorization alone.

The elements are federal and the same everywhere. States add rules for sensitive categories of records: HIV test results, mental health records, substance use treatment records, genetic information, reproductive health information. Where a state requires a category to be named before a provider releases it, the document names it; where a state releases a category only under a separate consent form, the document says it does not cover that category. Each state page states its state's rules from the record.

You sign and date it; federal law requires no witness and no notary. It ends when you revoke it in writing or at your death, or on a date you choose. Revocation is a letter to each provider that received it, and a disclosure already made before the revocation stands.

What a HIPAA Release Does

A HIPAA release is the written authorization the federal privacy rule requires before a provider or health plan may disclose your protected health information to someone you choose. It goes by several names, a medical records release, an authorization to release health information, a HIPAA authorization, and every one is the same document, with elements federal law fixes: what is released, to whom, for what purpose, when it ends, your signature and the date, and how you revoke it.

The people you name receive information and copies; they make no decisions for you. A healthcare power of attorney names a decision-maker, and the one prepared here appends this same authorization for the agent. Signing the release is your signature and the date; federal law asks for no witness and no notary.

States add rules for sensitive categories of records: HIV test results, mental health records, substance use treatment records, genetic information, reproductive health information. In many states one or more of these must be named expressly before a provider releases it, and a few release a category only under a separate consent form. The document carries each state's rules from the same record the healthcare power of attorney reads, and a state that adds nothing gets the federal form.

Select your state to prepare the authorization with your state's rules in place, the people you name, and the expiration you choose.

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Select your state to prepare the authorization with your state's rules in place, the people you name, and the expiration you choose.

Free HIPAA Release

Your State and Your Name

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Free HIPAA Release

Your State and Your Name