HIPAA Authorization Form - Step 1

A signed HIPAA authorization is like a permission slip that permits healthcare providers to disclose your health information to anyone you specify and it does not have to be notarized or witnessed.

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Questions related to your HIPAA Authorization document.

1

Enter the name of the health care provider (hospital, physician, etc.) who would then be authorized to disclose your health information to anyone you specify below.

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2

Enter the name of the person who is authorized to receive the information.

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