If a parent chooses to share their medical records with you, someone else, or a specific organization, they must complete a Health Insurance Portability and Accountability Act (HIPAA) release form.

As they age, your parents may need help with their healthcare. This could involve helping them with Medicare or other health insurance paperwork or accompanying them to medical appointments.

They may consider allowing you or someone else access to their medical records so you can better manage their health or treatment plans.

Your parents can ask their healthcare facility or doctor’s office for a HIPAA release or disclosure form. They must complete the form to allow the sharing of their medical records. They may choose to share their entire medical record, only specific health information, or their health records from between select dates.

If your parents are unable to complete the HIPAA form, you can still access their medical records, but you may need to go through legal channels.

HIPAA ensures that individuals and those they authorize can access the health records that hospitals, healthcare facilities, and health plan providers may carry.

For you to access your parents’ medical records, they must each complete a HIPAA release form.

People who live in California and Texas must fill out different HIPAA forms. These forms will likely look different from the one described below, although similar information will be required.

HIPAA release form section 1

Section 1 asks that your parent fills in their name and the name of the office or facility that holds their medical records.

Section 1 example

I, [insert parent name], give my permission for [insert doctor, healthcare professional, or facility name] to share the information listed in Section 2 of this document with the persons or organizations I have specified in Section 4 of this document.

HIPAA release form section 2

Section 2 asks your parent to specify the health information they want to share.

Section 2 example

I would like to give the above healthcare organization permission to:

☐ Disclose my complete health record, including, but not limited to, diagnoses, lab test results, treatment, and billing records for all conditions.

OR

☐ Disclose my complete health record except for the following information:

  • mental health records
  • communicable diseases including but not limited to HIV and AIDS
  • alcohol or drug misuse treatment records
  • genetic information
  • other (please specify)

Form of disclosure:

☐ Electronic copy or access via a web-based portal

☐ Hard copy

HIPAA release form section 3

Section 3 asks why your parent wants to release their health records.

If they prefer not to answer this question, they can write “at my request” here.

HIPAA release form section 4

Section 4 asks who they want their medical records shared with.

Section 4 example

I give authorization for the health information detailed in section II of this document to be
shared with the following individuals or organizations:

  • Name: [Your parent can choose to add yours or someone else’s name here.]
  • Organization name: [Your parent can choose to add an organization’s name here.]
  • Address: [Your parent must insert the address of whomever they are sharing their medical records with here.]

I understand that the persons or organizations listed above may not be covered by state and federal rules governing the privacy and security of data and may be permitted to further share the information that is provided to them.

HIPAA release form section 5

Section 5 asks whether your parents would like to specify a timeframe in which they would like to share their health information.

This authorization to share my health information is valid:

☐ From [insert date] to [insert date]

☐ All past, present, and future periods

☐ The date of the signature in section 6 until the following event:

[Here, your parent would specify the event, such as if they move to a new house.]

I understand that I am permitted to revoke this authorization to share my health data at any time and can do so by submitting a request in writing to:

  • Name: [insert doctor or healthcare professional name]
  • Organization: [insert organization name]
  • Address: [insert doctor/healthcare professional/organization address]

Section 5 continues to explain the revocation rules surrounding the authorization your parents are providing. They must confirm that they understand that:

  • In the event that their information has already been shared by the time the authorization is revoked, it may be too late to cancel the permission to share their health information.
  • They do not need to give any further permission for the information detailed in section 2 to be shared with the persons or organizations listed in section 4.
  • A failure to sign or submit this authorization or the cancellation of this authorization will not prevent them from receiving any treatment or benefits that they are entitled to receive, as long as this information is not required to determine whether they are eligible to receive those treatments or benefits or to pay for the services they receive.

HIPAA release form section 6

Section 6 requires that your parent signs, dates, and prints their names.

This confirms their request to release their medical records.

If you are legally authorized to act on your parent’s behalf and are requesting that their medical records be released to another doctor or organization, you must also complete a continued part of section 6.

This part asks for your name and signature, as well as details relating to your legal authority to act on your parent’s behalf.

If your parents cannot complete the HIPAA release form, you must become a:

  • healthcare power of attorney
  • court-appointed legal guardian
  • general power of attorney
  • durable power of attorney that includes the power to make healthcare decisions

In each case, you must go through a legal process to ensure that your parent’s best interests are kept at the forefront of any healthcare decisions.

Your parents must complete a HIPAA form in order for their medical records to be shared.

The HIPAA form will name the doctor or facility that should release the medical records, the type of information your parent would like released or withheld, who should receive the records, and for how long they should be available.

If they cannot complete the form themselves, you will need to explore legal options so that the courts may grant a medical power of attorney.