Get Your Medical Records
Released, Fast
A HIPAA-compliant authorization under 45 C.F.R. § 164.508 that works with any doctor, hospital, or healthcare facility in the United States.
Start My Authorization →Instant PDF download
What's in the Authorization
45 CFR § 164.508 Compliant
Covers all six required elements: who, what, to whom, why, when it expires, and the right to revoke.
Works for Any Facility
Hospitals, primary care, specialists, dental offices, mental health providers, and urgent care.
30-Day Legal Deadline
Your authorization triggers a federal 30-day response clock, facilities that ignore it risk OCR complaints.
How to Submit Your Authorization
- 1
Print the form.
- 2
Sign and date in ink in the signature field.
- 3
Deliver to the medical records department, in person or by certified mail.
- 4
Ask for a dated receipt or confirmation number.
- 5
If the facility does not respond within 30 days, file a complaint with the HHS Office for Civil Rights at hhs.gov/ocr.
Frequently asked questions
What is a HIPAA authorization form?▾
A HIPAA authorization is a written permission document that allows a covered entity (your doctor, hospital, or insurer) to disclose your protected health information to a third party. It must meet all six requirements of 45 C.F.R. § 164.508.
How long does a healthcare facility have to respond?▾
Under 45 C.F.R. § 164.524, covered entities must act on your request within 30 days. If they need more time, they can extend by 30 days with written notice.
Can I request mental health records with this form?▾
Yes. Mental health records are protected health information under HIPAA. Some states (California, New York) have additional restrictions on psychotherapy notes, the form notes this and you may need a separate state-specific form for psychotherapy notes specifically.
Can I revoke a HIPAA authorization after signing?▾
Yes. You may revoke your authorization at any time in writing, except to the extent that the covered entity has already taken action in reliance on it.
kweldoc documents are drafting tools, not legal advice. Review any authorization before signing. Consult a qualified attorney for complex medical or legal situations. kweldoc is not a law firm.