Authorization for Release of Protected Health Information (HIPAA)

A HIPAA Authorization is a document that allows doctors to share medical information with specifically named individuals. This document can give health care providers and insurance companies permission to release your protected health care information with certain individuals you name in the document.

In addition to the HIPAA document, you will need the Medical Power of Attorney document. Without the Medical Power of Attorney document, the Agent named in your HIPAA document will not be allowed to make a medical decision for you.

Click here to download and print a PDF of the HIPAA Authorization questionnaire worksheet.
This worksheet can be useful in preparation to fill out the online questionnaire.