AUTHORIZATION FOR RELEASE OF (PHI - UCLA Health - uclahealth 2025

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(a) Patients may authorize the release of their health care information by completing the CDCR 7385, Authorization for Release of Protected Health Information , to allow a family member or friend to request and receive an update when there is a significant change in the patient s health care condition.
A HIPAA release form is a document that when signed allows healthcare providers to share a patients protected health information (PHI) with specified individuals or organizations, ing to the details stipulated in the form.
A covered entity must obtain an authorization to use or disclose protected health information for marketing, except for face-to-face marketing communications between a covered entity and an individual, and for a covered entitys provision of promotional gifts of nominal value.
The patient must provide the authorization of release of PHI to the covered entity. If the patient does not provide a written authorization of release of PHI, the doctor may not release the PHI even if the patient gives verbal permission.
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.
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