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The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. A HIPAA release form must be obtained from a patient before their protected health information can be shared for non-standard purposes.Protected Health Information: Any information that can be linked back to the individual applicant, can be in any form: written, electronic, or verbal. If an Authorization for research is obtained, the actual uses and disclosures made must be consistent with what is stated in the Authorization. Complete "Legal Medical Record. When is a HIPAA Authorization to Release Medical Information Form Required? Request access, authorize disclosure via forms or in writing. Disclosure of patient health care records in Wisconsin. Lehner. Request access, authorize disclosure via forms or in writing. What is the process for completing a written Health Care Provider certification?