HIPAA Authorization Form
A HIPAA authorization form gives permission to an entity such as a doctor, healthcare provider, or attorney to collect and share a patient’s protected health information for non-standard purposes. Make sure medical information is stored and handled according to HIPAA regulations with this free HIPAA Authorization Form. Simply customize the form to meet your needs and email a form link to the involved parties to begin accepting signatures online. Patients can use any device to provide their personal information, select what type of sensitive medical information can be disclosed and by whom, and indicate the reason for disclosure before completing the form with an electronic signature. You’ll receive all submissions in your secure Jotform account, protected by HIPAA friendly features with a plan upgrade.
Customizing your HIPAA Authorization Form is easy with our drag-and-drop Form Builder. Without any coding, you can add more form fields for medical information, file uploads, payments, signatures, and more. Feel free to change the template design and even upload your logo to make this template match your organization. And to speed up your workflow and stay better organized, integrate your HIPAA Authorization Form with other apps you rely on — such as Google Drive or Dropbox — to sync submissions to those accounts. Get consent to release sensitive health information and protect your patients’ privacy with an online HIPAA Authorization Form.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
