All Legal Templates Vault Cart View Cart
Vault Document

$19.95

Healthcare Insurance Portability and Accountability Act (HIPAA) Waiver

HIPAA Waiver

Our Health Insurance Portability and Accountability Act - HIPAA - waiver allows you to authorize multiple people who will be able to request, review, and receive your confidential medical information. The HIPAA Privacy Rule established federal standards geared towards protecting individuals’ medical records and other personal health information. As such, this rule requires appropriate safeguards to protect the privacy of personal health information by setting limits and conditions on the uses and disclosures without patient authorization.

Once specified, your chosen third party representatives will be able to see and act on your personal medical information. This template allows a patient to include the names of family members, friends, and other third parties. Furthermore, anyone that asks a healthcare provider or other party for your medical information that is not specifically listed in this document will be denied under the penalty of federal law. Finally, our template can be revoked or reassigned at any time by simply filing a new version of the form.

Another benefit associated with this document is that aside from the parties listed, you can grant your general power of attorney the ability to review your medical records. As any copy of this completed document must be accepted as though it were the original, you are able to clearly state exactly who you would like to have access to your medical records.

Finally, our document must be signed and sealed by a notary public. This step ensures that your documents will not be forged and protects against unauthorized third parties from accessing your confidential medical records. Most banks, post offices, or government buildings will have a notary public available during operating hours. Use our Health Insurance Portability and Accountability Act (HIPAA) form to quickly and easily authorize family and friends to view and act upon your otherwise private medical records. If you would like more information regarding estate planning, check out our blog.

HIPPA Waiver