WHAT IS THIS FORM USED FOR?
The AUTHORIZATION FOR EMPLOYER TO RELEASE MEDICAL INFORMATION is used to provide an employer the authorization to use or disclose medical information which it possesses pertaining to its employees. It may be prepared by an employer and provided to the employee/patient for signing. Or it may be prepared and signed by the employee/patient and provided to the employer. Either way, the patient/employee (or an authorized representative as explained below) must sign the document.

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.

In addition to the protections explained in the FAQ for Authorization For Health Care Provider To Release Medical Information, the Act prohibits employers from using or disclosing medical information they possess about employees unless the employee/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 an AUTHORIZATION FOR EMPLOYER TO RELEASE MEDICAL INFORMATION by using the Intelligent Questionnaire for Authorization for Employer 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 an employer that falls within the foregoing definition cannot be released without the employee/patient's written Authorization.


ARE THERE EXCEPTIONS TO THE AUTHORIZATION REQUIREMENT?

There are exceptions to the Act's prohibition on an employer's use or disclosure of medical information. Under certain circumstances, an employer may use or disclose an employees medical information without a written Authorization. To read these exceptions and circumstances, click here to read California Civil Code section 56.20.


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

The requirements of a valid authorization for an employer to disclose medical information are set forth in California Civil Code section 56.21.

You can quickly and easily prepare a valid authorization that complies with this code section by using the Intelligent Questionnaire for Authorization for Employer 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 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 an employer pursuant to the Act is governed by California Civil Code section 56.24. This section makes a cancellation or modification effective only upon actual receipt by the employer 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 employer in such a way that you can prove it was actually received by the employer. 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 EMPLOYER TO RELEASE MEDICAL INFORMATION.


LEGAL DISCLAIMER
By visiting and using this website, you agree to our Terms and Conditions.

The material above is NOT a complete explanation of the law regarding the form's subject matter -- it only provides specific legal information regarding the associated form. It is not intended to provide information outside the scope of the associated form. It is intended to explain only certain legal concepts in simple terms in order to help the reader understand what the form is for and how it's generally used.

Also, the above information is not legal advice. It is GENERAL legal information that merely states the law. If you need legal advice about your own particular situation, you must hire an attorney that can listen and apply the law to your specific facts. Online Self-help Legal Tool for California Forms cannot and does not practice law and cannot help you with your individual problem.

Also, the foregoing information and the form related hereto pertain only to California law, unless indicated otherwise at the top of the corresponding . This website does not have information regarding federal law or the laws of other states.