| 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
- Gather patient info, recipients, disclosing parties, PHI scope, and purpose.
- Draft using the template below, ensuring all eight required elements are present.
- Add sensitive-category addenda and state-required execution blocks.
Prerequisites
- Patient legal name, DOB, and contact details.
- Authorized recipient(s) — full names, roles, contact details.
- Disclosing party(ies) — named provider(s) or broad covered-entity language.
- PHI scope and date range, including any specially protected categories.
- Purpose of disclosure aligned with healthcare agent duties.
- Expiration date or event.
- Personal representative authority documentation (if patient is not signer).
- 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 |
|
