HIPAA Authorization Form
Control who can see your medical info. Share it with the people who matter.
Your health information is private—but in a crisis, the right people need access fast. A HIPAA Authorization lets you give specific people legal permission to talk with your doctors and view your medical records. Without it, even close family members may be left in the dark.
With Duckpins, you can create and share your HIPAA Authorization in just a few clicks—secure, legal, and ready when you need it.
EASY • AFFORDABLE • LEGALLY BINDING
Create Your HIPAA Form—Without the Lawyer Price Tag
$25
Includes:
Your HIPAA Form: Customized to match your preferences.
60-Day Vault Access: Try out your personal, secure document vault for free for 60 days.
Share Access with Loved Ones: Give decision-makers instant access when it matters most.
Online Notarization Available for a fee: Sign and notarize everything from your couch in record time.
Get Your HIPAA Form Now
Why You Need a HIPAA Authorization Form
Ensure Your Loved Ones Can Stay Informed
Without a HIPAA Form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Without a HIPAA Form, doctors cannot legally share your medical details—even with your spouse, adult children, or parents.
Prepare for Medical Emergencies
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
In case of an unexpected illness or accident, your trusted person will have the legal authority to communicate with doctors and access medical records.
Make Care Coordination Easier
Need to gather and share information between providers? Ensure the right people can access and share your medical history by executing a HIPAA Form.
Need to gather and share information between providers? Ensure the right people can access and share your medical history by executing a HIPAA Form.
It only takes a few minutes to protect your healthcare information—but it makes all the difference when it’s needed.
Get Your HIPAA Form NowWhat Is a HIPAA Authorization Form?
A HIPAA Authorization Form is a legal document that allows a healthcare provider to share your medical records with a designated person or entity.
Without this authorization, even your closest family members may not be able to access your medical information.
A HIPAA Form:
Identifies the patient (you)
Specifies what medical information can be shared
Names who can receive your records
Outlines how long the authorization is valid
Gives you the right to revoke permission at any time
What’s Included in a HIPAA Authorization Form?
A HIPAA-compliant authorization form must contain the following details:
Recipient of Information
Specify who can access your medical records
This could be a family member, legal representative, or another doctor
Scope of Information
Choose what medical details can be shared, such as:
Medical history
Test results & diagnoses
Mental health records
Expiration Date or Event
Decide how long the authorization remains valid
Some people choose no expiration to ensure access when needed
Right to Revoke
You have the legal right to cancel your authorization at any time
The form must explain how to revoke access
Patient’s Signature & Date
The document must be signed and dated to be legally valid - and it should be notarized
Duckpins makes it easy to create, store, and share your HIPAA Authorization Form—so your medical information is always accessible when needed.
Get Your HIPAA Form NowState Requirements for Medical Release Forms
In addition to federal HIPAA regulations, each state may have its own privacy laws governing medical record access.
State-Specific Regulations May Cover:
Additional protections for mental health, substance abuse, or reproductive health records
Specific rules for parental consent & minor patient rights
Extra authorization steps for HIV/AIDS-related medical history
All Duckpins HIPAA forms are fully compliant with Washington State laws.
Get Your HIPAA Form NowSee How Easy Your HIPAA Form Can Be
Duckpins helps you create and understand your documents, with tools and guidance in simple language.
Why Choose Duckpins?
Online & Legally Binding
Every document is legally valid and tailored to you—no appointments, no paperwork, just easy and online.
Every document is legally valid and tailored to you—no appointments, no paperwork, just easy and online.
Fast & User-Friendly
Just answer a few questions and your documents are ready in minutes.
Just answer a few questions and your documents are ready in minutes.
Transparent Pricing
Pay once or subscribe—get just what you need or everything at once.
Pay once or subscribe—get just what you need or everything at once.
Secure & Shareable
Manage all of your documents from your secure digital vault—easy to access, easy to share.
Manage all of your documents from your secure digital vault—easy to access, easy to share.
Online Notarization Available
Need it notarized? Do it from your couch. Our built-in notary service makes it fast and easy (for a small fee).
Need it notarized? Do it from your couch. Our built-in notary service makes it fast and easy (for a small fee).
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