PHI release form


What is a PHI release form?

A PHI release form or a protected health information release form is used to disclose health information to a person or entity. Usually, a medical practice uses the PHI release form to release a particular patient’s health information to a third party. Patient health information is protected under the Health Insurance Portability and Accountability Act  (HIPAA), and the PHI release form is used to allow the release of this information under the correct guidelines set by HIPAA.

Why is a patient health information form necessary?

A PHI (protected health information) form is necessary because it helps to ensure that personal medical information is only shared with those who have a legitimate need to know and that it is only shared in accordance with the individual’s wishes. This is important because medical information is highly sensitive and personal, and it is important to protect it from unauthorized access or disclosure.

What information does the patient health information release form entail?

A PHI (protected health information) release form typically includes the following information:

  1. The patient’s name, address, and other personal identification information.
  2. The person or entity to whom the information will be released.
  3. The specific information that will be released to the person or entity. May include information pertaining to a particular time period.  This may include medical records, test results, treatment plans, and other types of personal medical information.
  4. The purpose for which the information will be used.
  5. For how long do you want to release the information?
  6. The individual’s signature, indicating their consent to the release of the information.
  7. A witness signature, if required.

Who fills out the patient health information release form?

The phi release form is typically filled out by the patient who intends to release his/her medical information. In case the medical information to be released is that of a minor, the parents/guardians of the minor would fill out the form.

It is also possible that the medical practitioner fills outs the form on behalf of the patient if the patient is unable to do so because of any reason.