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HIPAA Authorization Form (Form 960)

Jed Dietrich, Esq. Is Regarded to be a Best Lawyer of America, and With Over Twenty Years of Experience is Prepared to Represent Individuals with their Personal Injury Claims.


HIPAA document The Health Insurance Portability and Accountability Act (HIPAA) Form 960 is a document that allows for the release of an individual’s personal medical information to a specified entity. By signing the form, an individual is granting their healthcare provider or doctor permission to disclose their medical history to a specific person or organization.

For over 20 years, Jed Dietrich, Esq. has successfully represented individuals in personal injury cases throughout the Western New York area. Today, he is regarded to be a Best Lawyer of America and is fully capable of assisting you with any questions or concerns you might have. To receive your free consultation, call us now at 716-839-3939 or visit us online.

What Is A HIPAA Authorization Form?

The Health Insurance Portability and Accountability Act (HIPAA) was instituted in 1996 for the purpose of regulating the release of patients’ personal medical information. The intention of the act was to protect individuals’ rights and privacy by regulating how that information was released. The HIPAA Privacy Rule, implemented to augment HIPAA, established further safeguards regarding the release of individuals’ medical information. The Privacy Rule established standards that had to be followed by covered entities. This was to ensure not only that health information could be released but also that the covered entities would take steps to see that information safeguarded once it was in their possession.

It is common practice for health care providers to distribute a HIPAA Privacy Form to every new patient, informing them of their rights regarding the release of personal health information. This form is different from the HIPAA Authorization Form, which is strictly used for the release of your medical records and information. When you sign a HIPAA Authorization Form, you are confirming your consent to release protected health information (PHI) to the person or entity specified on the form. The form must include the name and address of the person releasing the information, the name and address of the person or entity to whom the information is being released, the time limit during which the form is valid, and the purpose for which the form is being used.

In personal injury cases, you can usually restrict access to your medical records further by designating the date of the accident and the specific body parts that were affected by your accident. The Dietrich Law Firm P.C.’s veteran team will help you fill out this and many other important forms related to your accident. Our highly experienced team will protect your right to privacy by ensuring that we only disclose the necessary medical documents.

At the Dietrich Law Firm P.C., we understand the life-changing effects of personal injury. A personal injury accident can permanently alter your way of life. As such, the importance of finding the right representative for your personal injury case cannot be overstated. Our team of top rated personal injury attorneys is more than capable of representing you. Please call us today at 716-839-3939 or contact us online for your consultation.

Frequently Asked Questions

Person and documents It is not uncommon to have questions when it comes to filling out a HIPAA Authorization Form. Often, the circumstances that require this form involve a personal injury claim. The following are some of the frequently asked questions regarding the HIPAA Authorization Form:

  1. What are “covered entities?” Covered entities are “individuals and organizations subject to the Privacy Rule,” such as a patient’s healthcare providers.
  2. Who can sign a HIPAA Authorization Form? The form is signed by the patient releasing the information or by an individual acting on the patient’s behalf.
  3. Do HIPAA Authorization Forms need to be notarized? No, HIPAA Authorization Forms do not have to be notarized.
  4. Can I cancel my HIPAA Authorization Form? Individuals have the right to revoke their HIPAA Authorization Form at any time, as is specified on the form. There is also an option to specify the length of time that an entity has access to your health information. In a personal injury claim, you can choose to have your HIPAA Authorization Form expire at the close of litigation.
  5. Why do I need to disclose my medical records? In a personal injury claim, the burden of proof is on the plaintiff. In essence, you must prove your claim and your alleged injuries in order for your claim to be successful. Medical records and other documentation of your injuries serve to strengthen your claim and give you the best opportunity to receive the highest compensation possible.
  6. Where can I find a sample HIPAA Authorization Form? You can find a sample form here.

At the Dietrich Law Firm P.C., we pride ourselves on always going the extra mile for our clients. We happily assist all of our clients in filling out this and other important forms related to their accidents, and we would be honored to help you. If you are in the process of filing a personal injury claim in Buffalo, New York, and are struggling with questions or uncertainty, the Dietrich Law Firm P.C. is here to assist you. Our team of top rated personal injury lawyers can help answer any questions you might have regarding your personal injury claim. Our offices are open 24 hours a day and 7 days a week. Reach out to us today at 716-839-3939 or contact us online, and we will help you in the best way possible.

WERE YOU, OR A LOVED ONE, INJURED IN BUFFALO, NEW YORK?

CALL JED DIETRICH, ESQ. AND HIS TEAM OF QUALIFIED BUFFALO, NEW YORK PERSONAL INJURY ATTORNEYS AT 716-839-3939 NOW TO OBTAIN THE HELP THAT YOU NEED!


Call the Dietrich Law Firm P.C. immediately at 716-839-3939 so that our aggressive, tenacious and hardworking personal injury lawyers can fight to obtain the best result for your personal injury claim in Buffalo, New York. We are available 24 hours a day, 7 days a week, and there is never a fee until we WIN for you!

Client Reviews
★★★★★
I am a medical doctor and have worked with many of the best lawyers in Buffalo and I can say without question that Jed Dietrich is the only lawyer I would trust with my injury case in Buffalo New York. B.O.
★★★★★
Dogged, Determined, and Dead-set on getting you the Maximum settlement for your injuries! T.F.
★★★★★
No one will work harder, smarter or better; I have retained Jed and he obtained the best result for my case. D.P.
★★★★★
The definition of an "A" type personality-exactly who I would want to represent me in a serious personal injury case. E.S.
★★★★★
Jed is a Master in the courtroom without an equal. S.C.
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