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HIPAA Authorization 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 as a patient, you have the right to access your medical records. Any request you make to access or transfer records must be fulfilled within 30 days. If for some reason the request cannot be handled in that timeframe, you must be provided a letter explaining the delay.
That said, there is a process you must follow to obtain records from a clinic, hospital, etc:
Put in a Formal Request
The organization may require you to formally request the records in writing for documentation and compliance purposes. You can use a HIPAA release form, which you can create on this page or download a free template. The key sections to complete are:
- Releasor & Recipient: Who owns the records and who will receive them
- History Length: What timeframe do you want covered
- Record Type: Do you want all records in that timeframe or just those related to a specific condition
- Expiry Date: For legal purposes, set an expiration 6-12 months out
Submit for Processing
Ask the facility for their specific rules on submitting the release document. Also request how they can deliver the records, as options may include email, hand delivery, flash drive, etc. There may be fees for processing and searching for the records, but submitting the request is free.
Getting your medical records
Modern healthcare facilities have adapted and no longer need the full 30 days to transfer records. On average, it takes a few business days. If after 7 business days, you have not received the records, you can call to check if there are any issues. If the facility takes 30 days and still has not delivered the requested records, they must notify you in writing explaining the delay. They can then request one 30-day extension period – this is the legal limit for extensions.
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: $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 | § 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 | 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 | § 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