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HIPAAAuthorization To Release Health Information PDF Free Download
Medical Records Release Authorization
The process to get HIPAA-compliant medical records
It’s important to note that you, as the patient the medical records concern, have the right to access your medical records.
Any request you make to access or transfer your medical records must be fulfilled within 30 days.
If for some reason, the request cannot be handled within that time, a letter must be given explaining why the facility is unable to provide the requested records.
With that being said, there is a process that you must go through before you can get your medical records from a clinic, hospital, etc.
Put in a request for the records
The organization that’s handling your medical records may ask that you formally request your records (instead of asking for them verbally).
This is so that they have documentation of the request so they can be in compliance with the applicable laws and in case legal action is taken against them for any reason.
You can quickly fill out the document by using the HIPAA medical release authorization form creator on this page (click create the document) or download our free template.
We recommend the first option because it’ll reduce the potential to make errors when filling the template.
The sections that need to be completed are:
Releasor & Recipient – Who owns the records and who will get the records
History length – What time frame do you want the release records to cover
What type of record – Do you want all the records within that time period to be released or only the ones related to a specific condition or incident?
Expiry date – These are for legal purposes and it’s best practice to include them. If you’re not sure then set it for 6 months to a year.
Submit for processing
Each medical facility has its own rules and regulations related to how they want you to send the release document.
Simply ask them what their process is.
You can also request how they should forward your records to you.
Of course, they will only have certain options so it’s important to figure out what they are beforehand. For example, can it be emailed as a
pdf, delivered by hand, placed on a flash drive, etc? There may be a fee for processing the request and searching for records but the act of submitting a request is free.
Getting your medical records
Modern healthcare facilities have adapted to the times and no longer need the entire thirty days to transfer records.
On average, it takes a few business days.
If, after seven business days, you’ve not gotten the records then you can call to find out if there’s any problem.
If the facility takes 30 days and still hasn’t delivered the requested records then, as mentioned previously, they have to notify you in writing about why there is a delay.
They can then request an extension of 30 days.
They can only request a single extension period according to the law.
The Process to get HIPPA medical records for another person
There are cases where someone will need to get medical records on behalf of another person and the law recognizes this.
There are three ways to go about this process.
Is There a Fee ($) to Release Medical Records?
Yes, but this depends on the medical office and the state it is located. Generally speaking, smaller offices do not require a fee for copying and transferring medical records. If a medical office does charge a fee, it cannot be more than the statutory limit (see table below):
State-by-State Maximum Limits ($)
| State | Maximum Fees ($) | Laws |
| Alabama | Search Fee: $5Pages 1-25: $1/pagePages 26+: $0.50Other Documents: Actual cost of reproduction. | § 12-21-6.1 |
| Alaska | N/A | No Statute |
| Arizona | Reasonable Fee | § 12-2295 |
| Arkansas | Search Fee: $15Pages 1-25: $0.50/page page 26+: $0.25/page | § 16-46-106 |
| California | Search Fee: $4Evidence Fee: $15Pages 1+: $0.10/page microfilm: $0.20/page | EVID Code § 1158(2) & § 1563(6) |
| Colorado | Search Fee: $18.53 flat fee (First ten pages)Pages 11 – 40: $0.85 per page pages 41+: $0.57 per page microfilm: $1.50 per page | 6CCR 1011-1 Chapter 2 Part 5.2.3.4 |
| Connecticut | Pages 1+: $0.65 per page | § 19a-490b |
| Delaware | Pages 1 – 10: $2.00 per page 11 – 20: $1.00 per page 21 – 60: $0.90 per page pages 61+: $0.50 per page microfilm: Actual cost of reproduction. | Title 24: Chapter 1700, Section 29 |
| Florida | Search Fee: $1.00 (Per year per request)Pages 1+: $1.00 per page microfilm: $2.00 per page | § 395.3025 (1) |
| Georgia | Search Fee: $25.88Pages 1 – 20: $0.97 per page 21 – 100: $ 0.83 per page pages 101+: $0.66 per page certification Fee: $9.70 | § 31-33-3 |
| Hawaii | Reasonable Fee | § 622-57(g) |
| Idaho | N/A | No Statute |
| Illinois | Search Fee: $29.09Pages 1 – 25: $1.09 per pagePages 26 – 50: $0.73 per pagePages 50+: $0.36 per page microfilm: $1.82 per page | 735 ILCS 5/8-2005 |
| Indiana | Search Fee: $20.00 (includes first 10 pages)Pages 11 – 50: $0.50 per page pages 51+: $0.25 per page affidavit/Certification: $20.00 | 760 IAC 1-71-3(a) |
| Iowa | Reasonable Fee | § 622.10 |
| Kansas | Reasonable Fee | REPEALED |
| Kentucky | First (1st) Copy: FreeSecond (2nd) Copy: $1.00 per page | § 422.317 |
| Louisiana | Search Fee: $25.00Pages 1 – 25: $1.00 per pagePages 26 – 350: $0.50 per pagePages 351+: $0.25 per pageMax Fee for Electronic Records: $100.00 per request | § 1165.1 |
| Maine | Search Fee: $5.00 (Includes the first page)Pages 2+: $0.45 per page max Fee: $250.00Max Fee for Electronic Records: $150.00 per request | § 1711-A |
| Maryland | Search Fee: $22.88Pages 1+: $0.83 per page electronic Records Search Fee: $22.88Electronic Records Pages 1+: $0.62 per page max Fee for Electronic Records: $81.63 per request | § 4-304 |
| Massachusetts | Search Fee: $25.01Pages 1 – 100: $0.84 per page pages 100+: $0.43 per page Social Security: No charge for a request to support a claim under the social security act. | Title XVI, Ch III, Section 70 |
| Michigan | Search Fee: $25.38Pages 1 – 20: $1.27 per pagePages 21 – 50: $0.63 per pagePages 51+: $0.25 per page | Public Act 47 of 2004. MCL 333.26269 |
| Minnesota | Search Fee: $19.19Pages 1+: $1.44 per page-rays: $10 Search Fee plus the actual cost of reproduction. | § 144.292 |
| Mississippi | Search Fee: $20.00 Flat Fee (first 20 pages)Pages 21 – 100: $1.00 per page pages 101+: $0.50 per page search/Storage Fee: $15.00 (Only charged if records are retrieved from off-site location)Certification Fee: $25.00 | § 11-1-52 |
| Missouri | Search Fee: $26.06Pages 1+: $0.60 per page storage Fee: $24.40 (Additional fee if records are retrieved off-site)Max Fee for Electronic Records: $114.17 | § 191.227.5 |
| Montana | Search Fee: $15.00Pages 1+: $0.50 per page | § 50-16-540 |
| Nebraska | Search Fee: $20.00Pages: 1+: $0.50 per page-rays: Actual cost of reproduction. | § 71-8404 |
| Nevada | Pages 1+: $0.60 per page-rays: Reasonable Fee | § 629.061 |
| New Hampshire | Whichever is greater: $15 for the first 30 pages or $0.50 per page X-rays: Reasonable Fee | § 332-I |
| New Jersey | Search Fee: $10.00Pages 1 – 100: $1.00 per pagePages 101+: $0.25 per pageMax Fee: $200.00 | § 8:43G-15.3, § 13:35-6.5 |
| New Mexico | Pages 1 – 15: $30.00 flat feet ages 16+: $0.25 per page-rays: Actual cost of reproduction. | § 16.10.17.8 |
| New York | Pages 1+: $0.75 per page-rays: Actual cost of reproduction. | Title 2: Section 17 |
| North Carolina | Pages 1 – 25: $0.75 per pagePages 26 – 100: $0.50 per pagePages 100+: $0.25 per pageMinimum Fee: $10.00 | § 90-411 |
| North Dakota | Search Fee: $20.00 (Includes pages 1-25)Pages 26+: $0.75 per page electronic Records Search Fee: $30.00 (Includes pages 1-25)Electronic Records Pages 26+: $0.25 per page | § 23-12-14 |
| Ohio | Search Fee: $20.42Pages 1 – 10: $1.34 per pagePages 11 – 50: $0.69 per pagePages 51+: $0.27 per pageX-rays: Search Fee plus $2.27 per page | § 3701.742 |
| Oklahoma | Search Fee: $10.00Pages 1+: $0.30 per page-rays: $5.00 per page max Fee: $200.00 | § 76-19 |
| Oregon | Search Fee: $30.00 (Includes pages 1-10)Pages 11-50: $0.50 per page pages 51+: $0.25 per page-rays: Actual cost of reproduction. | OAR 847-012-0000 |
| Pennsylvania | Search Fee: $23.45Pages 1 – 20: $1.58 per pagePages 21 – 60: $1.17 per pagePages 61+: $0.40 per page microfilm: $23.45 + $2.33 per page | 48 Pa.B. 7712 |
| Rhode Island | Pages 1 – 10: $2.50 per pagePages 10 – 50: $0.75 per pagePages 51+: $0.50 per page | R5-37- MD/DO Section 11.2 |
| South Carolina | Search Fee: $26.67Pages 1 – 30: $0.69 per pagePages 31+: $0.53 per pageMax Fee for Electronic Records: $160.05 | § 44-115-80 |
| South Dakota | No Current Fee Schedule | § 36-2-16 |
| Tennessee | Search Fee: $18.00 (Includes pages 1 – 5)Pages 6 – 50: $0.85 per pagePages 51 – 250: $0.60 per pagePages 251+: $0.35 per page | § 63-2-102 |
| Texas | Search Fee: $48.77 (Includes pages 1 – 10)Pages 11 – 60: $1.64 per pagePages 61 – 400: $0.80 per pagePages 401+: $0.44 per page | §241.154 |
| Utah | Search Fee: $21.16Pages 1 – 40: $0.53 per pagePages 41+: $0.32 per page | 78B-5-618 |
| Vermont | Whichever is greater: $5 or $0.50 per page Social Security: No charge for a request to support a claim under the social security act. | § 9419 |
| Virginia | Search Fee: $20.00Pages 1 – 50: $0.50 per page pages 51+: $0.25 per page max Fee: $150.00Electronic Records Search Fee: $20.00Electronic Records Pages 1 – 50: $0.37 per page electronic Records Pages 51+: $0.18 per page electronic Records Max Fee: $150.00Microfilm Search Fee: $20.00Microfilm Pages 1+: $1.00 per page | § 8.01-413 |
| Washington | Search Fee: $26.00Pages 1 – 30: $1.17 per page page 31+: $0.88 per page | WAC 246-08-400 |
| West Virginia | Search Fee : $20.00Pages 1+ : $0.40 per pagePages 1+ Electronic Records: $0.20 per pageMax Fee Electronic Records: $150 | § 16-29-2 |
| Wisconsin | Search Fee: $22.61Pages 1 – 25: $1.14 per page 26 – 50: $0.86 per page 51 – 100: $0.56 per page pages 101+ $0.34 per pageMicrofilm and other media: $22.19 + $1.68 per page-rays: $22.19 + $11.28 per series certification (if not patient or their representative): $9.04 per request |
| Author | – |
| Language | English |
| No. of Pages | 3 |
| PDF Size | 1 MB |
| Category | Form |
| Source/Credits | eforms.com |
Authorization to Release Health Information HIPAA PDF Free Download