Completing Your HIPAA Authorization

A HIPAA Authorization allows you to give trusted people permission to receive and discuss your health information with the doctors, hospitals, and other health care providers you name.

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This form does not give someone authority to make medical decisions for you. That is handled separately through an Advance Directive or other health care planning document.

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Before You Begin

Think about who should be able to receive your medical information. This may be your spouse, an adult child, another family member, or a trusted friend who may help coordinate your care.

You will also need to identify the doctors, hospitals, or health care organizations that you want to be able to share your information.

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Completing the Form

• Enter your personal information and list the health care providers you want covered by the authorization.​

• List the people who may receive your information. Include current contact information whenever possible.

  • ​You can authorize access to your complete medical record or limit the authorization to certain types of information.​

• Review the expiration section carefully. Under Maryland law, this type of authorization generally cannot remain in effect for more than one year, so it should be reviewed and renewed regularly.​

• Finally, read the authorization, sign it, and date it.​

After You Sign

Give a copy to each health care provider listed on the form and to the people you have authorized. Keep another copy with your important planning documents.

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Some doctors or hospitals may require you to complete their own HIPAA authorization form. If so, follow their instructions as well.

Review your authorization each year or whenever your doctors, trusted contacts, or wishes change.

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Remember: A HIPAA Authorization helps the people you trust access your medical information. Your Advance Directive determines who may make health care decisions for you when necessary.