HIPAA Authorization Form: Control Who Has Access to Your Medical Information
Ensure the Right People Have Access to Your Healthcare Information—When It Matters Most
Your healthcare information is private—but there may be times when you need a trusted family member, caregiver, or another provider to access it.
A HIPAA Authorization Form gives you control over who can receive your medical records and what information they can access. Whether you’re:
Having your medical care managed by a family member
Transferring to a new healthcare provider
Facing an unexpected medical emergency
Having a HIPAA Authorization Form in place ensures your medical information can be shared smoothly—on your terms.
Let's Get StartedWhat Is a HIPAA Authorization Form?
A HIPAA Authorization Form is a legal document that allows a healthcare provider to share your medical records with a designated person or entity.
Without this authorization, even your closest family members may not be able to access your medical information.
A HIPAA form:
Identifies the patient (you)
Specifies what medical information can be shared
Names who can receive your records
Outlines how long the authorization is valid
Gives you the right to revoke permission at any time
Make Your HIPAA Form in Minutes
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Why You Need a HIPAA Authorization Form
Ensure Your Loved Ones Can Stay Informed
Without a HIPAA form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Without a HIPAA form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Prepare for Medical Emergencies
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
Make Care Coordination Easier
Need to gather and share information between providers? Having a HIPAA form allows your chosen family members or friends to ensure your medical history is easily transferred.
Need to gather and share information between providers? Having a HIPAA form allows your chosen family members or friends to ensure your medical history is easily transferred.
It only takes a few minutes to protect your healthcare information—but it makes all the difference when it’s needed.
Let's Get StartedWhat’s Included in a HIPAA Authorization Form?
A HIPAA-compliant authorization form must contain the following details:
Recipient of Information
Specify who can access your medical records
This could be a family member, legal representative, or another doctor
Scope of Information
Choose what medical details can be shared, such as:
Medical history
Test results & diagnoses
Mental health records
Expiration Date or Event
Decide how long the authorization remains valid
Some people choose no expiration to ensure access when needed
Right to Revoke
You have the legal right to cancel your authorization at any time
The form must explain how to revoke access
Patient’s Signature & Date
The document must be signed and dated to be legally valid - and it should be notarized
Duckpins makes it easy to create, store, and share your HIPAA Authorization Form—so your medical information is always accessible when needed.
Let's Get StartedState Requirements for Medical Release Forms
In addition to federal HIPAA regulations, each state may have its own privacy laws governing medical record access.
State-Specific Regulations May Cover:
Additional protections for mental health, substance abuse, or reproductive health records
Specific rules for parental consent & minor patient rights
Extra authorization steps for HIV/AIDS-related medical history
All Duckpins HIPAA forms are fully compliant with Washington State laws.
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