Authorization Statement
Clear, dated patient authorization specifying what records may be released, to whom, and for what purpose; reference to HIPAA consent language where applicable.
A properly drafted request reduces delays, minimizes privacy risk, and ensures requested records are accepted by providers, payers, or courts.
Common participants include treating providers, patients or their authorized representatives, attorneys, insurers, and custodian-of-record staff.
Each participant has specific responsibilities: requesters must obtain valid consent, providers must verify identity and legal basis, and recipients must safeguard received records.
| Field | Configuration |
|---|---|
| Authentication | Email link, SMS code, or higher-assurance KBA for sensitive records |
| Template | Pre-fill standard consent language and required fields |
| Routing | Define signers and order; include provider and legal recipient |
| Storage | Encrypted archival (PDF/A) with audit trail |
Use platforms that support secure delivery, authentication, and audit trails when transmitting PHI or legal records.
Clear, dated patient authorization specifying what records may be released, to whom, and for what purpose; reference to HIPAA consent language where applicable.
Exact medications, refill history, or date range requested to avoid overbroad disclosures and speed retrieval by records custodians.
Name and contact details of the person or entity receiving records and any fax/email constraints for secure transmission.
Instructions for acceptable ID, two-factor options, or power-of-attorney documents required to validate the requester.
Include notarization clause when required by state law or provider policy; allow for RON if accepted by custodian.
Statement about record retention, redaction responsibility, and the existence of an audit trail or certificate of completion for e-submissions.
30 days to respond; one 30-day extension allowed (45 CFR §164.524)
Often 5–30 business days depending on backlog and request complexity
May be required for urgent care or legal deadlines; document justification
Follow court schedule; custodians respond per judicial timeline
Keep copies per retention policy and legal hold requirements
| signNow | DocuSign | Adobe Sign | PandaDoc | HelloSign | |
|---|---|---|---|---|---|
| Starting Price | $8/user/mo | $15/user/mo | $14/user/mo | $19/user/mo | $15/user/mo |
| Free Plan | 7-day trial | No | No | Yes, limited | Yes, limited |
| Bulk Send | Yes | Yes | Yes | Yes | No |
| Audit Trail | Yes | Yes | Yes | Yes | Yes |
| HIPAA Compliant | Yes | Yes | Yes | No | No |