11+ Patient Authorization Form Examples in PDF | MS Word

“There are cases when you are unable to get your medical needs in person. At times like these, you will have to get someone to do it for you. But there are regulations on the access of someone else’s health information such as the Health Insurance Portability and Accountability Act of 1996 in the United States. These regulations make it restricting for others to help you with your medical needs. With a patient authorization form however, you are able to grant someone else permission to do whatever you need and follow the regulations. While health is a personal matter, like all issues you get to involve whoever you want as long as you trust them.”

11+ Patient Authorization Form Examples

1. Patient Authorization Form Example

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2. Universal Patient Authorization Form

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Size: 143 KB

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3. Patient Authorization Form Sample

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Size: 231 KB

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4. Patient Authorization and Release Form

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5. Basic Patient Authorization Form

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6. Patient Authorization Form in PDF

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7. Patient Authorization Form

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9. Patient Authorization Release Form Example

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Size: 108 KB

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10. Patient Contact Authorization Form

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11. Patient Authorization Release Form Sample

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12. Patient Authorization Form in DOC

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What is a Patient Authorization Form?

A patient authorization form is a document that grants permission to a person to make decisions and take action for the medical needs of someone else. The form’s content includes statements proving the person’s authorization, along with the signatures and names of both parties. The reason why this is a vital requirement is that according to an article by Forbes, healthcare is one of the most targeted industries for fraud and information breaches. This form is an insurance that does not happen to you.

How to Write a Patient Authorization Form?

With this form, you can allow a person access to your prescription medicine for you, obtain health information, and even let them make decisions on your treatment. It basically lets someone meet your medical needs when they are unable to do so yourself because of injury or lack of time. Continue reading this article if you have some challenges on where to get started.

1. Write Carefully and Specifically

Patient authorization forms can be used as proof for confidential decisions, so it must be written properly to avoid any trouble. When writing it down, make sure it is done carefully. Notate what you are allowing the person you authorize can do and not able to do as well. Before you sign the authorization form, double-check for any typos and mistakes. Have someone else check it for good measure as well. Once you are sure it is written right, you can add the signatures to complete the form.

2. Make Sure It Follows HIPAA Regulations

HIPAA also is known as the Healthcare Insurance Policy and Accountability Act, is a government act that seeks to protect everyone’s healthcare information. It ensures that your medical history and health issues are kept private without anyone taking advantage of it. That being said, it can make it a bit challenging for your representative to help you out with any medical needs. That is why your patient authorization form must be written in a way that follows HIPAA regulations.

3. Use The Right Terms

When doing the write up for your patient authorization form, use the correct medical terminology when you have to specify something. For example, if you are authorizing someone to get medicines for you, make sure to mention the medication by its official name. That way, your representative will not have any issues trying to obtain said medication. Instead of generalizing your letter, it is advisable to use the correct terms so that those who look through it will understand what your representative is authorized to do exactly.

4. Use an Organized Format

Keep your patient authorization form in an organized manner. That way, people can have an easy time reading through it. A proper format also makes the form look valid enough as well. As a formatting tip, you can use a bold font and underline important words like names and terminologies in your form. If you wish to make your own, you can take a look at our samples for reference.

FAQs

What is the purpose of a patient authorization form?

A patient authorization form allows you to grant someone the authority to make decisions for you regarding your health. They can also take actions such as acquiring medication or obtaining your medical records for you. This serves as an official pass so that someone can take care of your medical needs when you are unable to.

What is HIPAA?

HIPAA stands for the Health Insurance Policy and Accountability Act. This is an act that was made official in 1996 and is meant to protect the healthcare information of people with health insurance.

Do patient authorizations have to be in writing?

Yes. To follow HIPAA regulations, your authorization has to be written in clear and simple language, proving that authorization was handed over to a person you trust.

What do you need for a patient authorization form?

To have a verified authorization form, you will need the full name and signature of both yours and your representative. You also need to have carefully worded out statements that confirm you allowed a particular person to represent you for your medical needs.

Whether you are going to the doctor’s office or check on referral, your patient authorization form must have those written on paper properly. The medical industry takes patient confidentiality seriously, so you will have to have all the right kinds of authorizations for your representative to avoid any hold-ups. As long as you follow the steps as mentioned earlier you will be able to make a great authorization form that will help make every medical transaction go smoothly.