Published November 6, 2025

Authorization to Release Records — Free PDF (Private, No Upload)

Health providers, schools, and law offices often require a signed authorization before sharing protected records. CourtPDF’s Authorization to Release generator captures subject identity, scope, purpose, and expiration—rendering the PDF entirely in your browser to keep sensitive data private.

When to use a release authorization

Release forms show consent for sharing data protected by laws like HIPAA (health), FERPA (education), or state privacy statutes. Use one when:

• A clinic needs permission to send medical records to another provider or attorney.
• A school must share transcripts or disciplinary records with a parent or advocate.
• An employer is disclosing personnel files to legal counsel during an investigation.
• You want proof that a third party can obtain information on your behalf.

Keep a signed copy with your case files and consider logging related correspondence in EmailCourtor tracking exhibits in the Evidence Index generator.

What to include

Most organizations look for these elements:

• Subject name and date of birth (or other identifier).
• Releasing party (clinic, school, employer) and receiving party.
• Specific records or date ranges covered by the release.
• Purpose for the disclosure (treatment, legal review, insurance, etc.).
• Expiration date or event.
• Signature and date lines for the subject or authorized representative.

Sensitive data such as Social Security numbers should be redacted unless required. For identity verification, attach a Proof of Identity PDF or copy of government ID when appropriate.

Expiration & revocation

Set a concrete expiration date—many HIPAA-style forms default to one year. Recipients should stop relying on the form after that date. Individuals can revoke their authorization in writing before it expires; keep revocation letters with your files and notify any downstream recipients.

FAQs

Is the form enforceable?

A signed authorization demonstrates consent, but the releasing party still must follow applicable laws and policies. Some agencies may require their own format—use this template to gather the necessary information before filling out their official form.

Do I need a notary?

Most releases only need a signature and date. Certain institutions may request notarization for added assurance; call ahead to confirm.

Can I limit what’s disclosed?

Yes. Describe the exact records or time period you want shared. You can also note exclusions (for example, “exclude psychotherapy notes”).

CourtPDF Standard — Informational only, not legal advice.