Consent Form for Use or Disclosure of Patient Health Information

Use this sample form to obtain patient consent for use or disclosure of patient information as required by HIPAA and state law.

Attached Files

Glad we could be helpful. Thanks for the feedback.

Sorry we couldn't be helpful. Your feedback will help us improve this article.

How helpful was this page?

Updated on Wed, 11 Dec 2019 by Sydnee Funke