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.
For Utah 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
Who and what (Page 1) Name the people who may receive your information and choose what may be released. Initial any specially protected records you want included.
Sign before a notary (Page 2) Hospitals and insurers are more likely to accept a notarized authorization without question. Bring a current, government-issued photo ID.
This is Utah’s official optional form under the Uniform Health Care Decisions Act (effective January 1, 2026). It names an agent to make health care decisions if you cannot, and records your wishes about treatment and organ donation.
Utah’s Uniform Health Care Decisions Act lets you give advance instructions about mental health care and name an agent to make those decisions during a crisis.
Utah law lets you name the person who will have the right to make decisions about your funeral, burial, or cremation, ahead of the family members who would otherwise decide.
This form lets you tell a Utah court who you want as your guardian (personal care) and conservator (money and property) if you ever become unable to manage your own affairs, and who should never serve.
Use this form to cancel a Utah advance health care directive, including any power of attorney for health care, or an advance mental health care directive.
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.