The Authorization for Release of Records is a crucial document used across various sectors in the United States when there is a need to legally and securely transfer records or information from one party to another. This document type became particularly important with the implementation of major privacy legislation such as HIPAA, FERPA, and GLBA, which established strict requirements for handling sensitive personal information. The authorization serves multiple purposes: it provides clear documentation of an individual's consent, protects the record holder from liability, ensures compliance with privacy laws, and establishes clear parameters for what information can be released, to whom, and for what purpose. The document is commonly used in healthcare settings for medical records, educational institutions for academic records, financial institutions for financial records, and various other contexts where protected information needs to be shared. Its format and content must comply with both federal and state-specific requirements, making it essential to consider the jurisdiction where it will be used.
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1. Individual's Information: Full identification details of the person whose records are to be released, including name, date of birth, address, and any relevant identification numbers
2. Record Holder Information: Details of the organization/entity currently holding the records, including name, address, and contact information
3. Recipient Information: Details of the person/organization authorized to receive the records, including name, address, and contact information
4. Records Description: Specific description of the records to be released, including type, date range, and any specific limitations
5. Purpose of Release: Clear statement of the purpose for which the records are being released
6. Duration of Authorization: Specific timeframe for which the authorization is valid, including expiration date
7. Rights Statement: Statement of the individual's rights, including right to revoke authorization and any limitations
8. Signatures: Space for signatures of the authorizing individual (or legal representative) and date, with any witness requirements
1. Special Instructions: Used when specific handling instructions or restrictions need to be included for the records
2. Legal Representative Authorization: Required when someone other than the individual is authorizing the release, including proof of authority
3. Sensitive Information Release: Required for specific sensitive information types (HIV, mental health, substance abuse) that need explicit authorization
4. Re-disclosure Notice: Required when HIPAA or other privacy laws prohibit re-disclosure of the information
5. Payment Information: Used when there are fees associated with the records release
6. Electronic Records Format: Used when specifying requirements for electronic record transfer or format preferences
1. Schedule A - Detailed Record List: Itemized list of specific records to be released when the main description section is insufficient
2. Schedule B - Special Handling Instructions: Detailed instructions for handling, transmitting, or processing the records
3. Appendix 1 - Glossary: Definitions of technical or medical terms used in the authorization
4. Appendix 2 - State-Specific Requirements: Additional requirements or notifications required by specific state laws
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Education
Financial Services
Insurance
Legal Services
Human Resources
Government
Social Services
Real Estate
Employment Services
Relevant Teams
Legal
Compliance
Human Resources
Medical Records
Information Security
Risk Management
Operations
Administrative Services
Customer Service
Privacy
Data Management
Relevant Roles
Privacy Officer
Compliance Manager
Medical Records Administrator
HR Manager
Legal Counsel
Risk Manager
Records Coordinator
Healthcare Administrator
School Registrar
Financial Services Manager
Insurance Claims Processor
Medical Office Manager
Corporate Secretary
Information Security Officer
Data Protection Officer
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