HIPAA Medical Release FormAI Template IconToolbar IconShare Icon

HIPAA Medical Release Form

Use our HIPAA Medical Release Form template for compliant disclosure of protected health information while maintaining privacy and regulatory standards.

Olivia Sayson avatar

By Olivia Sayson on Aug 18, 2025.

Fact Checked by Gale Alagos.

Use Template

Commonly asked questions

Yes, a signed authorization is generally required unless the disclosure falls under HIPAA exemptions, such as treatment, payment, or healthcare operations.

The validity period depends on state regulations and the terms specified within the form. It typically remains valid until revoked or upon expiration.

Yes, patients can revoke authorization at any time in writing, unless the disclosure has already occurred based on prior consent.

EHR and practice management software

Get started for free

*No credit card required

Free

$0/usd

Unlimited clients

Telehealth

1GB of storage

Client portal text

Automated billing and online payments