Forms

We have an array of release forms at our fingertips. Please contact us for any special requirements or the most current HIPAA release documents including:

  • Mental Health record release
  • Heirship Affidavit
  • Affidavit of Personal Representative

IRS Request for Copy of Tax Return

AUTHORIZATION FOR USE AND DISCLOSURE OF PHI (Protected Health Information)

FERPA - Consent to Release Student Information

SOCIAL SECURITY EARNINGS Release of Information

SOCIAL SECURITY ADMINISTRATION Release of Information

NEW YORK STATE Health Information Release

KAISER PERMANENTE Health Information Release

MILITARY RECORDS release form

DEPARTMENT OF VETERAN AFFAIRS Health Information Release

REQUEST FOR VA BILLING for Care Related to Personal Injury or Workers Compensation

Links

Patient’s Rights to obtain Personal Health Information – HIPAA 

Federal Register Volume 78, Issue 17 -Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules