AHIMA's Advocacy and Policy Efforts

AHIMA has created a model Patient Request for Health Information form to help providers streamline the process when patients request their protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) and comply with the timeframe and fees set out by the Office for Civil Rights’ (OCR) guidance of 2016.

HIPAA requires covered entities (health plans and most healthcare providers) to provide patients, upon request, access to their protected health information (PHI) maintained by or for the covered entity. Patients have the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity.

For those involved in release of information (ROI), a lack of consistency in the forms accompanying these requests can make it difficult to determine whether they should be approved or denied. This free form provides a standardized mechanism, written in plain language, that can be easily read and understood by patients and may be customized by providers and organizations to capture the data you need as well as organizational contact information.

The second page of the form explains how to use it and contains information and links to related HIPAA requirements and resources, including the OCR guidance.

Download the model form