hipaa-release-form

name	hipaa-release-form
title	HIPAA Release Authorization
description	Drafts HIPAA Release Authorization forms compliant with 45 CFR 164.508 for disclosure of protected health information. Typically used in estate planning or healthcare decision-making packets. Use when a client needs a HIPAA authorization, medical records release, PHI disclosure consent, healthcare agent access form, or advance directive bundle.
author	CaseMark
author_url	https://github.com/CaseMark/skills/tree/main/skills/legal/hipaa-release-form
license	Apache-2.0
version	0.1.0
execution_mode	open
jurisdiction	us
practice	healthcare
language	en
tags	["agreement","drafting","regulatory","transactional"]

HIPAA Release Authorization

Drafts a 45 CFR 164.508-compliant authorization allowing designated recipients to obtain PHI for healthcare decision-making.

Quick Start

1. Gather patient info, recipients, disclosing parties, PHI scope, and purpose.
2. Draft using the template below, ensuring all eight required elements are present.
3. Add sensitive-category addenda and state-required execution blocks.

Prerequisites

1. Patient legal name, DOB, and contact details.
2. Authorized recipient(s) — full names, roles, contact details.
3. Disclosing party(ies) — named provider(s) or broad covered-entity language.
4. PHI scope and date range, including any specially protected categories.
5. Purpose of disclosure aligned with healthcare agent duties.
6. Expiration date or event.
7. Personal representative authority documentation (if patient is not signer).
8. State-specific execution requirements (witness, notary, special disclosures).

Required Elements (45 CFR 164.508)

Element	Content
Patient identification	Full name, DOB; add contact details if used by providers
Disclosing parties	Specific provider(s) or broad covered-entity class
Recipients	Names and roles of agents/representatives
Description of PHI	Record types and date range
Purpose	Healthcare decision-making and agent duties
Expiration	Date or event (e.g., revocation or death)
Signature	Patient or personal representative with authority
Required statements	Revocation rights; effect of revocation; no-conditioning notice; redisclosure warning; right to a copy

Sensitive Information Addenda

Include explicit consent line for each applicable category:

Category	Notes
Mental health records	State law may require separate consent
Substance use treatment (42 CFR Part 2)	Separate Part 2-compliant consent likely required [VERIFY]
HIV/AIDS testing or treatment	Many states require specific authorization language