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The following privacy forms help individuals access their protected health information and exercise other privacy rights. This California HIPAA release form enables patients to permit any person or 3rd party organization to have access to their personal health records.Completion of this document authorizes the disclosure and use of health information about you. The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. No information is available for this page. I authorize and request the disclosure of all protected information for the purpose of review and evaluation in connection with a legal claim. UCSF Participant Authorization for Release of PHI for Research (PDF). UCSF Participant Authorization for Release of PHI for Research (PDF). HIPAA Authorization. To conveniently request medical records, FMLA and Disability certifications.