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Apostille from the Washington Secretary of State

HIPAA Authorization - Washington

Washington · 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.

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Who this form is for

For Washington 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.

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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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