The patient client or his her authorized representative must complete this form before Alberta Healt 2025

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How do I fill out a HIPAA release form? Provide instructions. Name the patient and individual authorized to use or disclose their PHI. Describe the information. Specify recipients. Specify the purpose of disclosure. Specify the time period. Detail their revocation rights. Obtain the patients signature.
An Authorized Representative is someone you can name and give access to your Protected Health Information (PHI). An Authorized Representative can be family members, friends, or any other individual you choose.
A healthcare consent form is a legal document that outlines a patients agreement to receive a particular treatment, procedure, or disclosure of their medical information.
A power of attorney is a written document that authorizes someone (referred to as the agent) to make decisions or take actions on someone elses (known as the principal) behalf.
Living wills and other advance directives include written, legal instructions that state the treatment you want for medical conditions when youre unable to make decisions for yourself. Advance directives guide choices for healthcare professionals and caregivers in certain situations.
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A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.
If you require assistance or have questions regarding making an access request for your Alberta Netcare records, or any other health information related questions, please contact the HIA Help Desk by calling 310-0000 (toll free) then 780-427-8089 or by emailing HIAHelpDesk@gov.ab.ca.

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