HIPAA Authorization (Patient) (NJ)

This form creates a HIPAA Authorization form, which enables certain trusted individuals to have access to your medical records and health information.

This HIPAA authorization only grants an individual or organization the permission to release your medical records and health information to the individual or organization you specify. It does not include any wishes or directions with regard to your care.

If you do not have an Advance Health Care Directive, it is strongly recommended that you consider having one drafted. An Advance Health Care Directive will authorize certain individuals to make health care decisions on your behalf in the event you are incapacitated or otherwise unable to make such decisions for yourself. It may also allow you to express certain wishes with regard to end of life care and organ donation. Note that, depending on your state, this might be referred to as a "Health Care Proxy" or "Health Care Power of Attorney."

If you have already signed an Advance Health Care Directive (appointing a health care agent/attorney-in-fact), you may not need a separate HIPAA authorization. You should review your Advance Health Care Directive to determine whether it contains HIPAA release language already, and whether the individual you want to receive your medical information and records is already named as a Health Care Agent. If it does not contain HIPAA release language, you may want to consider updating your Advance Health Care Directive.