Authorization for Disclosure of Protected Health Information Template

Share this authorization for disclosure of protected health information with your patients to improve your medical services, optimize your internal processes and digitize your business. To use this form, duplicate it in our form builder, customize it as you please, and share it online with simple copy-paste. 123FormBuilder includes various features and security protocols that are HIPAA-compliant.

Customize template

Copy this ready-made authorization for disclosure of protected health information template to your 123FormBuilder account. Here you can adjust it to include more input fields or form elements. To do that, you only need drag and drop efforts. Then change the form design, upload your logo, configure automatic responses or multiple email recipients.

Publish template

It goes without saying that this authorization to disclose protected health information form is mobile-friendly and looks good on any device. When your online form is ready to go, use the Publish tab in your editor to get the embed code for your website. This only requires copy-paste. The same is true for sharing the form link via email or any other web platform.

Collect & manage data

Manage confidential healthcare information with ease due to this authorization for disclosure of protected health information form. All the submissions get to live in a secure data repository. If you prefer, you can download data entries in CSV, Excel or PDF format. Also, many integration options are available in the Applications tab.

Optimize processes

Forget about paper mess and improve your record-keeping with an authorization for disclosure of protected health information form. Stay alert at all times due to real-time notifications via SMS or email each time someone completes the form. Plus, with a user-friendly interface and a coding-free experience, you can build exactly the online form you need with 123FormBuilder.