HIPAA Medical Records Authorization – Personal Injury

$10.00

HIPAA-compliant authorization for law firms to request medical records in a personal injury case. Includes space for letterhead.

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Description

This Medical Records Authorization is specifically tailored for personal injury representation and allows law firms to obtain medical records on behalf of a client. The document is HIPAA-compliant and includes space for your firm’s letterhead and logo for professional presentation to healthcare providers.

Features include:

  • Patient and provider identification fields

  • Specific record types and date range

  • Purpose of disclosure (personal injury legal representation)

  • Revocation language and one-year expiration

  • Optional notary section

  • Delivered in Microsoft Word format for fast editing

Essential for personal injury lawyers handling claims involving medical treatment, this template ensures your firm receives the documentation you need — quickly and legally.

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