HIPAA Authorization & Waiver


PublicLegal.com's HIPAA form was recommended on CNN.
CNN produced a segment, "If You Get Hit by a Bus Tomorrow," which recommended PublicLegal.com's HIPAA release form.

CNN report contained the following statement: "Don't forget the HIPAA release form. This is the often forgotten form [according to Marie Deveney, a trust and estates lawyer in Ann Arbor, Michigan]. Even though it's your own spouse or parent, or sibling who's sick, some hospitals won't release any medical information because of HIPAA privacy regulations. It can also be difficult to deal with insurance companies or doctors' offices on someone else's behalf without a HIPAA release form, she says. Lawyers often draw these up for their clients. Deveney says [PublicLegal.com's HIPAA release form] is pretty good, downloadable for $9.99."

Intended Usage:
This form is intended to function as a HIPAA addendum to a medical power of attorney or health care proxy, or as a standalone form, to authorize a health care provider or health insurance company to release a person's Individually Identifiable Health Information to a designated third party.

Description: The Health Insurance Portability and Accountability Act of 1996 ("HIPAA") limits disclosure of "Individually Identifiable Health Information" to certain individuals, including one's family and friends, regardless of one's state of health. This comprehensive, professionally drafted form provides HIPAA compliant legal authorization so that health care providers can disclose and discuss a patient's health care information to designated individuals (including an agent who is acting under a medical power of attorney).

Scope of Authorization: With this form, health care providers are expressly authorized to answer questions posed by the designee(s) and openly discuss with the designee(s) the person's condition, treatment, test results, prognosis, and all other information pertinent to the person's health care, even if he or she is fully competent to ask questions and discuss his or her medical condition.

Release of Liability: Further, the form provides a release to any health care provider who acts in reliance on the authorization from any liability that may accrue from releasing the person's Individually Identifiable Health Information and for any actions taken by the designee(s).

Durability: The authorization granted by this form is effective as of the date shown of its signing and shall not be affected by the individual's subsequent disability or incapacity.

Preview Availability: The HIPAA Authorization & Waiver is not available for preview. It is available for purchase only.

Document Length: This form consists of nearly 1,100 words on 3 pages.