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HIPAA Instructions for Clients

As members of our Carrier Family, many of you have executed a Health Care Power of Attorney as part of your estate planning package. In this document, you appointed a Medical Patient Advocate to make decisions for you related to all health care services including, but not limited to, the following: consenting to or refusing medical treatment; providing relief from pain; accessing your medical records; and employing or discharging physicians. This document, including all powers granted to your Patient Advocate, does not become effective until two doctors have declared you incompetent.

HIPAA Carrier Law

Maintaining control over your own medical decisions so long as you are healthy and able to is important, but we recognize that there may be a time prior to your incapacity when it would be convenient for your Patient Advocate to have access to your medical information. As such, we would like to give you the opportunity to sign a HIPAA release (Health Insurance Portability and Accountability Act) which will grant your Patient Advocate access to your protected health information, including medical records, medical billings, test results, and treatment options. The release may be signed at any time, and the signing is optional. If you have a spouse who has been declared incompetent by two physicians, please contact us for other options.

For your convenience, we have provided a link to the HIPAA release which will allow you to print and complete the form on your own, at no cost to you. Directions for completion can be found below. Alternatively, if you would prefer to have us complete the form for you, we are happy to do so for a fee of $175 for our current clients. This fee includes the preparation of the HIPAA release and a signing meeting with a Drafting Paralegal and an Attorney. At the signing meeting, we will add the signed release to your estate planning binder. If you would like assistance with the HIPAA release, please contact our office to schedule a meeting.

If you are not yet a member of our Carrier Family, please contact our office to schedule an Initial Estate Planning meeting with one of our Design Attorneys to discuss the planning options available to you.

Directions for Completion

Follow the link above to print your HIPAA release. If you are married, please print two copies – one for you and one for your spouse. Before you begin filling out the form, locate your estate planning binder from Carrier Law and find the tab labeled “Powers of Attorney – Health Care.” Please note that you have two different Powers of Attorney in your binder – one for financial decisions and one for health care decisions. You want the one titled “Durable Power of Attorney – Health Care.” This document will be between 5-6 pages long, and will have Acceptance pages attached for each of your Patient Advocates. If you are married, you will find two Health Care Powers of Attorney behind this tab – one for you and one for your spouse.

Once you have printed the HIPAA release and have located your Durable Power of Attorney – Health Care, you are ready to begin:

  1. On the HIPAA release, fill in your full legal name (first name, middle initial, last name) in the first sentence in paragraph one.
  2. To complete paragraph 2 on the HIPAA release, you’ll need to refer to your Durable Power of Attorney – Health Care. The first sentence on page one states the following:I, YOUR NAME, a resident of COUNTY OF RESIDENCE, Michigan, hereby designate PATIENT ADVOCATE, to serve as my patient advocate…The name of your Patient Advocate is what you are looking for. Go back to your HIPAA release and insert your Patient Advocate’s name into the first line of paragraph two. You may also have Successor Patient Advocates named in case your first choice is unable to act. To locate the names of your successor agents, go back to your Durable Power of Attorney – Health Care and find the section labeled “Nomination of Successor Agent.” It will likely be #11 in your Power of Attorney. Find the names of your Successor Agents and enter the names into the 2nd paragraph on your HIPAA release.Paragraph #2 on your HIPAA release will look like this:I grant my Personal Representative, Bill Smith, the power and authority to serve as my authorized Personal Representative for all purposes under HIPAA effective immediately. If my initial Personal Representative shall be unable or unwilling to act, then I appoint the following, in the order named, to act as successor Personal Representatives to serve with the same powers: first, Mary Jones; second, Ryan Smith; third, Sara Taylor.
  3. You’re almost finished! You must sign your HIPAA release in front of a Notary Public. You can stop by our office between the hours of 8am and 5pm to sign this document, or you can take the HIPAA release to your locate bank or credit union to sign in front of a Notary Public. Do not sign the form before you are in the presence of a Notary Public. They need to witness you signing the document in order to notarize your signature.
    On page 2 of the HIPAA release, enter the date you sign the document and your date of birth next to your signature line. The Notary Public will complete the remaining section on page 2.
  4. Once your HIPAA release has been signed and notarized, please mail a copy to our office so we can update your file, and place the original form with your estate planning binder for safe keeping.
  5. If you have any questions while completing the form, please contact Heather Green, one of our Drafting Paralegals, at (616) 361-8400 for assistance.
female doctor explains hipaa policy to elderly male patient

Completing the HIPAA release is optional. Keep in mind that if you choose to complete the HIPAA form and distribute fully executed copies to your Patient Advocate, they will have immediate access to your protected health information. If granting immediate access to your records is your intent, then this is precisely the step you’ll want to take. However, if you do NOT want your Patient Advocate to have immediate access to your protected health information, we recommend signing the HIPAA release and storing the original with your estate planning binder in a safe location without distributing copies to your Patient Advocate. This option will grant your Patient Advocate access to your protected health information only on your terms, or after two doctors have declared you incompetent.

Prepare before it's too late.

It’s important to have control over decisions regarding your own health, but what happens when you become incapable of making those decisions? We recommend that our clients download and sign our HIPAA release form before that happens so that your Patient Advocate has access to your protected health information when it is convenient for you. At Carrier Law, we help you protect your future.

Call Our Experienced Attorneys

We can help you answer any questions regarding our HIPAA release form. Contact us today and prepare before it’s too late.

(616) 361-8400

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