HIPAA Release Form

Use this HIPAA Release Form Template to obtain legally compliant authorization for sharing protected health information (PHI).

This HIPAA Release Form Template is designed to help healthcare providers, medical offices, and organizations obtain legally compliant authorization to disclose protected health information (PHI). The form clearly identifies the patient, specifies the information to be released, names the authorized recipient, defines the purpose of disclosure, and includes required expiration and revocation language in accordance with HIPAA Privacy Rule requirements. Fully customizable and easy to use, this template helps streamline compliance while protecting patient privacy.

All data collected can be made HIPAA compliant with our Enterprise plan after signing our Business Associates Agreement (BAA). Additionally, our data encryption capabilities can help ensure your data is secure at rest and in transit.