The HIPAA Authorization

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Click here to review some Frequently Asked Questions about HIPAA.

About the HIPAA Authorization

The "Privacy Rule" created by the regulations implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the California Confidentiality of Medical Information Act (CMIA) is intended to protect the privacy of your medical records. However, there may be circumstances where the restrictions of this rule will prevent someone whom you want to be able to access your medical records from doing so. Such people include those individuals you may have appointed to make the determination regarding whether or not you have become "incapacitated" for the purpose of triggering your agent's power under a Durable General Power of Attorney or the appointment of a successor Trustee of your trust. These trustworthy people you have appointed to make such an important decision may feel that due diligence requires a review of your medical records. Completing this form will allow your health care providers to disclose your medical records to the specific groups of people described in the form.

Completing the Form

Simply fill in your name at the top and sign and date at the end. Keep the original in a safe place where it will not be lost or destroyed. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to the individuals described in paragraphs 1(a) through 1(h). You have the right to revoke this authorization or replace this form at any time.

If you have any questions about how to complete this form, please call META law, inc. at (805)856-3400.