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HIPAA Privacy Rule Authorization For Release of Health Information Form - Digital

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An attorney-reviewed form to formally notify and obtain consent from employees if any of their personal health information (PHI) will be used or shared, as required under HIPAA privacy rules.   

HIPAA Privacy Rule Authorization for Release of Health Information Form

Under the HIPAA Privacy Rule, individuals must provide signed authorization to a covered entity before the business may use or disclose certain PHI. The only exempted entities are doctors, nurses, hospitals, psychologists, laboratory technicians, and other health care providers regarding PHI, X-rays, laboratory and pathology reports, diagnoses, and additional medical information for treatment purposes.

A fully completed HIPAA Privacy Rule Authorization for Release of Health Information Form permits additional businesses to use PHI for purposes other than treatment, payment, or health care operations. If information is shared without an individual’s knowledge or permission, the business could face penalties and lawsuits.

Our digital, attorney-reviewed HIPAA Privacy Rule Authorization for Release of Health Information Form is designed to help businesses inform individuals when the company would share PHI. The Form also acts as documentation to the individual authorizing that type of release.

 Features & Benefits Include:

  • A digital authorization and acknowledgment form to document required disclosures under the HIPAA’s Privacy Rule;

  • Attorney-reviewed to ensure adherence to applicable laws;

  • Printable, fill-in-the-blanks digital format for physical or electronic recordkeeping;

  • A detailed instruction sheet explaining how & when to use the form and how long to retain it.

Our attorney-reviewed form is designed to help employers:

  • Ensure compliance with notification and authorization requirements of the HIPAA Privacy Rule.

  • Obtain signed authorization from employees regarding sharing or disclosure of PHI for permissible legal purposes.


If you are not completely satisfied, you can cancel your order within seven (7) days of receipt for a full refund.


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