What's on this form
HIPAA authorization
Let a chosen person see your medical information.
- Patient and recipient
- What records may be released
- Purpose and an end date
- Revocation notice and signature
FREE FILLABLE PDF
Let a chosen person see your medical records. Free fillable PDF.
This PDF is in English.
What's on this form
Let a chosen person see your medical information.
Use it this way
Type in the PDF fields or print a blank copy. Sign only the way your state requires. Keep the original. Upload a copy to your vault so family can find it.
All four forms are free fillable PDFs.
Name someone to handle money, property, taxes, and accounts if you cannot.
Name someone to make health-care decisions if you cannot speak for yourself.
Find an estate planning attorney near you. Keep the signed original. Put a copy in your vault.