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Oregon · Attorney-Style Template

Oregon HIPAA Authorization Form

Fill-in-the-Blank · State-Specific · Instant Download

(New)

What's Included

Fill-in-the-blank Oregon HIPAA Authorization for Release of Protected Health Information. Compliant with Or. Rev. Stat. §§ 192.518 et seq. (Oregon Health Information) and 45 C.F.R. § 164.508. Covers authorized recipient identification, scope of health records to release (including mental health under ORS 179.505 and HIV/AIDS under ORS 433.045), purpose of disclosure, expiration, revocation rights, and Oregon notary block. Suitable for estate administration, healthcare proxy coordination, and insurance purposes. Instant .docx download.

Patient identification and authorization block
Authorized recipient designation
Covered healthcare provider(s) to release records
Granular description of records to release (checkboxes)
Psychiatric, substance abuse, HIV/AIDS, genetic record options
Purpose of disclosure (treatment, legal, estate, insurance)
Expiration date or event selection
Patient rights notices (revocation, voluntary, re-disclosure)
State-specific statutory compliance language
Personal Representative authority block
Witness attestation
Optional notary acknowledgment
HIPAA 45 C.F.R. §164.508 compliant

Who This Is For

  • Residents with straightforward estates
  • Individuals who want a solid will without attorney fees
  • Married couples (each spouse needs their own)
  • Anyone ready to get their affairs in order

NOT Appropriate For

  • Business owners with complex ownership interests
  • Blended families with competing inheritance claims
  • Property owners in multiple states
  • Taxable estates (over federal exemption)

Legal Disclaimer

This template is for informational purposes only and does not constitute legal advice. No attorney-client relationship is formed by purchase. Consult a licensed Oregon attorney for advice specific to your situation.

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