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Apostille from the Ohio Secretary of State

HIPAA Authorization - Ohio

Ohio · Fillable PDF · Free

Federal privacy law (HIPAA) limits who doctors, hospitals, and insurers can talk to about you. This authorization lets the people you name receive your health information so they can help you. Federal privacy law (HIPAA) limits who doctors, hospitals, and insurers can talk to about you. This authorization lets the people you name receive your health information so they can help you.

Download HIPAA Authorization - Ohio PDF · 3 pages. No account required.

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Who this form is for

  • For Ohio residents and families: hipaa authorization.

What you'll need

  • Read the supplied packet before filling in its fields.
  • Follow this document's signing, identification, witness and filing instructions.

How to complete it

  1. Who and what (Page 1) Name the people who may receive your information and choose what may be released.
  2. Sign before a notary (Page 2) Hospitals and insurers are more likely to accept a notarized authorization. Bring a current, government-issued photo ID.

Related Ohio forms

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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