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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. The release also allows the added option for healthcare providers to share information.These instructions will help you to complete the Authorization for Release of Health Information under the HIPAA (OCA960). I authorize and request the disclosure of all protected information for the purpose of review and evaluation in connection with a legal claim. Instructions for Completing our HIPAA Privacy Authorization Form. A HIPAA Authorization Form is a document that allows a medical provider to share specific health information with another person or group. This form is not a patient access request under 45 CFR 164.524. HIPAA Authorization is a document that authorizes the release of medical records which are protected under HIPAA. If the Authorizations you receive do not contain all 12 items, then the Authorization is not compliant for release of Protected Health Information. A general authorization for the release of medical or other information is NOT sufficient for this purpose.