Patient Authorization for Use and Disclosure of Protected Health Information 2025

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How to create a HIPAA compliant medical records 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.
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, according to the details stipulated in the form.
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