California Authorization to Release Medical Information
Use this form, which complies with California and Federal laws, including HIPAA, to request a copy of your medical records or to authorize the release your medical records to someone else. For use only in California.
You have the right to see your own medical records and to authorize the release of your medical information to others. Use this form to:
to get a copy of your own medical records
to authorize release of records to someone else
for peace of mind, before you or your loved ones need it
Before you purchase this form: Check with your health care provider to see if it has its own form for authorizing the release of medical records. If it does, your health care provider may prefer that you use that one. Use this form when your provider does not have its own, or when you want to provide a general authorization.