{"product_id":"ohio-hipaa-authorization-template","title":"Ohio HIPAA Authorization \/ Release Template","description":"\u003cp\u003e\u003cstrong\u003eOhio HIPAA Authorization \/ Release Template\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003eAn Ohio HIPAA Authorization \/ Release template with completion notes and the blank form. Ohio adults and caregivers who want family members to be able to talk with doctors and get medical records.\u003c\/p\u003e\n\u003ch3\u003eWhat's included\u003c\/h3\u003e\n\u003cul\u003e\u003cli\u003e\n\u003cstrong\u003eHIPAA Authorization \/ Release\u003c\/strong\u003e (10 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), with an optional written release of HIV test results naming recipients and a time period (Ohio Rev. Code 3701.243), an optional consent for mental health hospitalization records (Ohio Rev. Code 5122.31), an optional psychotherapy-notes exhibit, and a revocation form.\u003c\/li\u003e\u003c\/ul\u003e\n\u003cp\u003eEach document starts on its own page with plain-English completion notes, followed by the blank form. Where Ohio law supplies a form or required notice, the statutory wording is reproduced verbatim.\u003c\/p\u003e\n\u003ch3\u003eSigning requirements (Ohio)\u003c\/h3\u003e\n\u003cul\u003e\u003cli\u003eHIPAA Authorization \/ Release: signature and date only; no witnesses or notary are required. The optional HIV release and mental health records consent are signed separately.\u003c\/li\u003e\u003c\/ul\u003e\n\u003ch3\u003eFile formats\u003c\/h3\u003e\n\u003cp\u003eEditable Word (.docx) and print-ready PDF (US Letter) for every document, delivered as a ZIP digital download. Nothing is shipped.\u003c\/p\u003e\n\u003cp\u003eLegal research last verified September 29, 2026.\u003c\/p\u003e\n\u003cp\u003e\u003cem\u003eThis is a fill-in template, not legal advice. Laws change; check your state's current requirements before signing.\u003c\/em\u003e\u003c\/p\u003e\n\u003cp\u003eLicensed to the original purchaser for personal use only; not for resale or redistribution.\u003c\/p\u003e\n\u003cp\u003e\u003cem\u003eSome content in this template was drafted with the help of AI tools and reviewed before listing.\u003c\/em\u003e\u003c\/p\u003e","brand":"Rexford Mercantile","offers":[{"title":"Default Title","offer_id":67610293960858,"sku":"OHIO_HIPAA_AUTHORIZATION_TEMPLATE","price":12.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0750\/8531\/6250\/files\/ohio-hipaa-authorization-template-01-cover.jpg?v=1790726482","url":"https:\/\/rexfordmercantile.com\/products\/ohio-hipaa-authorization-template","provider":"Rexford Mercantile","version":"1.0","type":"link"}