California HIPAA Authorization / Release Template

California HIPAA Authorization / Release Template

A California HIPAA Authorization / Release template with completion notes and the blank form. California adults and caregivers who want family members to be able to talk with doctors and get medical records.

What's included

• HIPAA Authorization / Release (9 pages): lets the people named receive protected health information from doctors, hospitals and health plans. Built on the federal core elements (45 C.F.R. §164.508) and California's Civil Code §56.11 rules, including 14-point type. Includes a separate stand-alone psychotherapy-notes authorization and a revocation form.

Each document starts on its own page with plain-English completion notes, followed by the blank form. Where California law supplies a form, the statutory wording is reproduced verbatim.

Signing requirements (California)

• HIPAA Authorization / Release: signature and date only; no witnesses or notary are required.

File formats

Editable Word (.docx) and print-ready PDF (US Letter) for every document, delivered as a ZIP digital download. Nothing is shipped.

Legal research last verified September 29, 2026.

This is a fill-in template, not legal advice. Laws change; check your state's current requirements before signing.

Licensed to the original purchaser for personal use only; not for resale or redistribution.

Some content in this template was drafted with the help of AI tools and reviewed before listing.