HIPAA Release Form Template

About this template

HIPAA (Health Insurance Portability and Accountability Act), also known as Public Law 104-191, is a law passed in the United States that protects and safeguards the privacy of medical information and has two main purposes: First, to provide continuous health insurance coverage to workers who switch jobs or lose their jobs; Second, is to standardize the electronic transmission and transactions for security and protection of information. This law was primarily passed due to proliferation of data breaches concerning health information.

This HIPAA Release Form PDF Template is a standard release authorization form for disclosure of health information for healthcare and health insurance providers which the subject or person consents on disclosing his health information to a certain healthcare organization. This HIPAA Release Form PDF Template is easy to modify and flexible to use.

Looking for more information about HIPAA form, please visit the page referred.

Related templates

Hospital Discharge Template

The Hospital Discharge Template is a detailed document that provides patients with instructions and information upon discharge from a healthcare facility

Professional Physical Therapy Consent Template

Create a professional physical therapy consent form. Collect e-signatures on any smartphone, tablet, or desktop. Easy to customize and share.

Free Non-Compete Agreement Template

Create a free non-compete agreement with Jotform Sign. Easy to customize and share. Converts to a PDF document. Fill out and e-sign on any device.

Professional Medical Release Template

Create a professional medical release template. Great for medical practices and therapists. Collect signatures online. Converts to PDF. Easy to customize and share.

Background Check Template

Create a custom background check form for your business. Converts into PDF. Easy to share and embed. Works on any device. Android and iOS compatible. No coding.

NonProfit Donation Consent Template

Create a nonprofit donation consent form in seconds. Drag-and-drop to design and customize. Collect signatures from any smartphone, tablet, or desktop.

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.