How to fill out is the HIPAA release form

This template is needed to release your health care information. It is protected by the Health Insurance Portability and Accounting Act, created by the United States Congress. Since this law statement became legal, no one can get an access to your medical records until you give a permission by completing this form. If you try to find one to use you may ask your personal health care provider med help lakeshore to give you an appropriate blank or find an electronic version online. To fill a template, insert the following information:

• personal data;
  
• information not to be disclosed;
  
• date or event upon which this authorization expires;
  
• signature of a member.
  

from Medical Release Form https://medicalreleaseform.tumblr.com/post/167226152306
via Medical release form
from Tumblr https://jeemiahmelville.tumblr.com/post/167226302657