| name | hipaa-release |
| title | HIPAA Release Authorization |
| description | Drafts a HIPAA Release Authorization form compliant with 45 CFR § 164.508 for authorizing disclosure of protected health information. Use when drafting HIPAA authorizations, PHI release forms, medical records releases, or healthcare privacy waivers alongside healthcare powers of attorney or advance directives. |
| author | CaseMark |
| author_url | https://github.com/CaseMark/skills/tree/main/skills/legal/hipaa-release |
| license | Apache-2.0 |
| version | 0.1.0 |
| execution_mode | open |
| jurisdiction | us |
| practice | healthcare |
| language | en |
HIPAA Release Authorization
Drafts a 45 CFR § 164.508-compliant authorization for disclosure of protected health information, typically executed alongside healthcare powers of attorney or advance directives. Output is a single execution-ready form with all client-specific fields marked in [BRACKETS].
Prerequisites
Gather before drafting:
- Patient info — full legal name, DOB, address
- Healthcare agent(s) — names and relationships (primary + successor)
- Cross-reference document — Healthcare POA or Advance Directive
- Jurisdiction — state witness/notary rules, sensitive-category consent requirements
- Scope instructions — whether to include mental health, substance abuse, HIV/AIDS, genetic info
Form Sections
Generate all sections in order:
| # | Section | Key Content |
|---|
| 1 | Title | "Authorization for Release of Protected Health Information Pursuant to HIPAA" |
| 2 | Patient Identification | Full legal name, DOB, address; statement: "I authorize the use and disclosure of my PHI as described in this authorization." |
| 3 | Authorized Recipients | Each agent by name and role: [Agent Name], designated as my Healthcare Agent; include successors |
| 4 | Disclosing Parties | Broad: "Any health plan, physician, healthcare professional, hospital, clinic, laboratory, pharmacy, medical facility, or other covered entity that has provided payment, treatment, or services to me or possesses my PHI." |
| 5 | Scope of Information | Default comprehensive: complete medical record, mental health, substance abuse treatment, HIV/AIDS, genetic info. Flag state carve-outs needing separate consent. |
| 6 | Purpose | "To enable my designated healthcare agent(s) to make informed healthcare decisions on my behalf, communicate with my providers, and access all information necessary to execute their duties under my Healthcare POA or Advance Directive." |
| 7 | Duration & Expiration | Effective immediately; remains until written revocation or death. State whether authorization survives incapacity. |
| 8 | Revocation Rights | Required § 164.508 statements — see checklist below |
