WHAT IS THIS FORM USED FOR?
The AUTHORIZATION FOR HEALTH CARE PROVIDER TO RELEASE MEDICAL INFORMATION is intended for use by a patient to authorize the release of his/her medical information to a third party. The form is provided to the health care provider, contractor, or health care service plan that will be releasing the patient's medical information to the third party.

If instead you want to inspect or copy your own medical records, you should click here to use the form REQUEST TO INSPECT AND COPY PATIENT RECORDS.


DOES CALIFORNIA LAW PROVIDE FOR PRIVACY OF MEDICAL INFORMATION?
Yes. Specifically, Part 2.6 of Division 1 of the California Civil Code, starting at section 56, called the Confidentiality of Medical Information Act ("Act"), sets forth the protections and conditions regarding the release of a patient's medical information. The Act prohibits the release of a patient's medical information by a health care provider, contractor, or health care service plan, unless the patient first signs an authorization allowing such release. There are exceptions to this general rule as will be explained more fully below.

You can quickly and easily prepare a AUTHORIZATION FOR HEALTH CARE PROVIDER TO RELEASE MEDICAL INFORMATION by using the Intelligent Questionnaire for Authorization for Health Care Provider To Release Medical Information.


WHAT INFORMATION IS PROTECTED?
It is important to understand that the Act protects the privacy of ONLY medical information. Medical Information is defined in California Civil Code section 56.05 as follows:
"Medical Information" means any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, or contractor regarding a patient's medical history, mental or physical condition, or treatment. "Individually Identifiable" means that the medical information includes or contains any element of personal identifying information sufficient to allow identification of the individual, such as the patient's name, address, electronic mail address, telephone number, or social security number, or other information that, alone or in combination with other publicly available information, reveals the individual's identity.
Thus, any information held by a health care provider, contractor, or health care service plan that falls within the foregoing definition cannot be released without the patient's written authorization.


WHAT INFORMATION IS NOT PROTECTED?

So what information can be released without your authorization? According to California Civil Code section 56.16, a provider can release at its discretion, upon an inquiry concerning a specific patient, the following information: The patient's name, address, age, sex, a general description of the reason for treatment, the general nature of the injury or condition, the general condition of the patient, and any information that is not medical information as defined above.

What if you don't want this information to be released? You have to make a written request to the provider that has your information that you do not want any information released about you, whether medical or not. You can use the form REQUEST TO MAINTAIN NON-MEDICAL INFORMATION CONFIDENTIAL to accomplish that.


ARE THERE EXCEPTIONS TO THE AUTHORIZATION REQUIREMENT?

According to the Act, there are certain circumstances under which your medical information can be released without your authorization. There are circumstances, in fact, where the release is mandatory. There are also circumstances where the release is discretionary.

Release Mandatory
There are situations where a health care provider, contractor, or health care service plan MUST release your medical information without your authorization. For example, your medical information must be released if compelled by a court order, or pursuant to a search warrant. California Civil Code section 56.10(b) lists the situations under which your medical information must be released even without your authorization.

Release Discretionary
There are situations where a health care provider, contractor, or health care service plan MAY release your medical information without your authorization. The release is at their discretion. For example, if it's necessary to provide treatment to a patient, then the information may be released. Or, for example, if the information is needed by an organization reviewing the competence of a health care provider, it may be released to such organization. California Civil Code section 56.10(c) lists the situations under which your medical information may be released even without your authorization. Also, please note that pursuant to California Civil Code section 56.104, if the medical information being sought relates to a patient's outpatient treatment with a psychotherapist, the requesting party must first provide to the releasing party a written request with specific information. This written request must also be provided to the patient within 30 days of receipt of the information.


HOW DO I PREPARE A VALID AUTHORIZATION FOR USE IN CALIFORNIA?

The requirements of a valid authorization for a health care provider to release medical information are set forth in California Civil Code section 56.11.

You can quickly and easily prepare a valid authorization that complies with this code section by using the Intelligent Questionnaire for Authorization for Health Care Provider To Release Medical Information.

After preparing a valid authorization, it must be properly executed in order to be valid. To properly execute an authorization, it must be signed and dated by one of the following:

  1. The patient.
  2. The patient's legal representative if the patient is a minor or an incompetent
  3. The spouse of the patient or the person financially responsible for the patient, if the following two conditions are met:
    • where the medical information is being sought for the sole purpose of processing an application for health insurance or for enrollment in a nonprofit hospital plan, a health care service plan, or an employee benefit plan, and
    • where the patient is to be an enrolled spouse or dependent under the policy or plan.
  4. The beneficiary or personal representative of a deceased patient.
Also, the signature should serve no other purpose than to execute the authorization.

Note: If the patient is a minor and the medical services furnished to the minor were of the nature that allowed the minor to lawfully consent to the services without a parent or legal representative, then the minor patient can sign and date this form, and a signature by a legal representative will not suffice to provide a valid authorization.


CAN I CANCEL OR MODIFY MY AUTHORIZATION?
Cancellation or modification of an authorization provided to a health care provider pursuant to the Act is governed by California Civil Code section 56.15. This section makes a cancellation or modification effective only upon actual receipt by the health care provider of written notice of the cancellation or modification. Thus, you must first put your cancellation or modification in writing. Thereafter, you must deliver it to the health care provider in such a way that you can prove it was actually received by the health care provider. For example, you can mail it via certified mail return receipt requested.


WHAT IF I WANT A COPY OF MY OWN RECORDS?
If you want to inspect or copy your own medical records, you should not use an authorization to release medical information. Instead, you should use a form called REQUEST TO INSPECT AND COPY PATIENT RECORDS.


THINGS TO CONSIDER

Certain types of medical records are subject to other laws and therefore may not be released by using an authorization that complies merely with the Confidentiality of Medical Information Act. Specifically, these types of medical records include:

1. Alcohol and drug abuse records
2. Records relating to HIV or AIDS patients
3. Records relating to mental health information
4. Records relating to developmental disabilities

This is not an exhaustive list. If you want to authorize the release of medical records that fall within or are related to any of the foregoing subject matters, DO NOT USE an AUTHORIZATION FOR HEALTH CARE PROVIDER TO RELEASE MEDICAL INFORMATION.


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