How to Complete a HIPAA Form

HIPAA stands for Health Insurance Portability and Accountability Act. The HIPAA privacy act prevents medical facilities from distributing patient information for anything except medical purposes. HIPAA was passed in 1996 and put into practice in 2003. The purpose of the HIPAA privacy act is to protect patient's privacy. Patients are provided with a privacy practices on their first visit or when they are admitted. After reviewing the privacy practices, patients sign acknowledgment and HIPAA rules are automatically in place. If patients choose to allow someone else access to their information, they need to fill out a HIPAA Privacy Authorization Form.

Things You'll Need

• HIPAA Privacy Authorization Form
• Pen or pencil

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Instructions

• 1

  Obtain a HIPAA Privacy Authorization Form from your physician or local hospital.

• 2

  Fill out the name of the health care provider authorized to release the information and the name of the person authorized to receive your medical information.

• 3

  Determine the time period you authorize the health care provider to release the information, as well as what information they can release.

• 4

  Specify how long the authorization form will remain in effect. This may be a specific date or until your death.

• 5

  Sign the form or have a parent sign the form if the patient is a minor.