HIPAA Release Form Florida
HIPAA Release Form Florida
Florida Medical Records Release Form with HIPAA Compliance
Click here for HIPAA release form
(free PDF document – Opens directly in browser)
This HIPAA release form Florida enables patients to permit any person or third parties to have access to private health records. The Florida medical records release form also optionally allows healthcare providers to share information with other healthcare providers. The HIPAA release form can be revoked and/or reassigned at any time. The form must be used because releasing medical records without a HIPAA release form is a federal HIPAA violation.
State Fees for Releasing Medical Records
| State | Maximum Fees ($) |
| Alabama | Medical Record Search Fee: $5
Copied Pages Supplied 1-25: $1/page Copied Pages Supplied 26+: $0.50 Other Documents: Actual cost of reproduction. |
| Arizona | Reasonable Fee |
| Arkansas | Medical Record Search Fee: $15
Copied Pages Supplied 1-25: $0.50/page Copied Pages Supplied 26+: $0.25/page |
| California | Medical Record Search Fee: $4
Evidence Fee: $15 Copied Pages Supplied 1+: $0.10/page Microfilm: $0.20/page |
| Colorado | Medical Record Search Fee: $18.53 flat fee (First ten Copied Pages Supplied)
Copied Pages Supplied 11 – 40: $0.85 per page Copied Pages Supplied 41+: $0.57 per page Microfilm: $1.50 per page |
| Connecticut | Copied Pages Supplied 1+: $0.65 per page |
| Delaware | Copied Pages Supplied 1 – 10: $2.00 per page
Copied Pages Supplied 11 – 20: $1.00 per page Copied Pages Supplied 21 – 60: $0.90 per page Copied Pages Supplied 61+: $0.50 per page Microfilm: Actual cost of reproduction. |
| Florida | Medical Record Search Fee: $1.00 (Per year per request)
Copied Pages Supplied 1+: $1.00 per page Microfilm: $2.00 per page |
| Georgia | Medical Record Search Fee: $25.88
Copied Pages Supplied 1 – 20: $0.97 per page Copied Pages Supplied 21 – 100: $ 0.83 per page Copied Pages Supplied 101+: $0.66 per page Certification Fee: $9.70 |
| Hawaii | Reasonable Fee |
| Illinois | Medical Record Search Fee: $29.09
Copied Pages Supplied 1 – 25: $1.09 per page Copied Pages Supplied 26 – 50: $0.73 per page Copied Pages Supplied 50+: $0.36 per page Microfilm: $1.82 per page |
| Indiana | Medical Record Search Fee: $20.00 (includes first 10 Copied Pages Supplied)
Copied Pages Supplied 11 – 50: $0.50 per page Copied Pages Supplied 51+: $0.25 per page Affidavit/Certification: $20.00 |
| Iowa | Reasonable Fee |
| Kansas | Reasonable Fee |
| Kentucky | First (1st) Copy: Free
Second (2nd) Copy: $1.00 per page |
| Louisiana | Medical Record Search Fee: $25.00
Copied Pages Supplied 1 – 25: $1.00 per page Copied Pages Supplied 26 – 350: $0.50 per page Copied Pages Supplied 351+: $0.25 per page Max Fee for Electronic Records: $100.00 per request |
| Maine | Medical Record Search Fee: $5.00 (Includes first page)
Copied Pages Supplied 2+: $0.45 per page Max Fee: $250.00 Max Fee for Electronic Records: $150.00 per request |
| Maryland | Medical Record Search Fee: $22.88
Copied Pages Supplied 1+: $0.83 per page Electronic Records Medical Record Search Fee: $22.88 Electronic Records Copied Pages Supplied 1+: $0.62 per page Max Fee for Electronic Records: $81.63 per request |
| Massachusetts | Medical Record Search Fee: $25.01
Copied Pages Supplied 1 – 100: $0.84 per page Copied Pages Supplied 100+: $0.43 per page Social Security: No charge for a request to support a claim under the social security act. |
| Michigan | Medical Record Search Fee: $25.38
Copied Pages Supplied 1 – 20: $1.27 per page Copied Pages Supplied 21 – 50: $0.63 per page Copied Pages Supplied 51+: $0.25 per page |
| Minnesota | Medical Record Search Fee: $19.19
Copied Pages Supplied 1+: $1.44 per page X-rays: $10 Medical Record Search Fee plus the actual cost of reproduction. |
| Mississippi | Medical Record Search Fee: $20.00 Flat Fee (first 20 Copied Pages Supplied)
Copied Pages Supplied 21 – 100: $1.00 per page Copied Pages Supplied 101+: $0.50 per page Search/Storage Fee: $15.00 (Only charged if records are retrieved from off-site location) Certification Fee: $25.00 |
| Missouri | Medical Record Search Fee: $26.06
Copied Pages Supplied 1+: $0.60 per page Storage Fee: $24.40 (Additional fee if records are retrieved off-site) Max Fee for Electronic Records: $114.17 |
| Montana | Medical Record Search Fee: $15.00
Copied Pages Supplied 1+: $0.50 per page |
| Nebraska | Medical Record Search Fee: $20.00
Copied Pages Supplied: 1+: $0.50 per page X-rays: Actual cost of reproduction. |
| Nevada | Copied Pages Supplied 1+: $0.60 per page
X-rays: Reasonable Fee |
| New Hampshire | Whichever is greater: $15 for first 30 Copied Pages Supplied or $0.50 per page X-rays: Reasonable Fee |
| New Jersey | Medical Record Search Fee: $10.00
Copied Pages Supplied 1 – 100: $1.00 per page Copied Pages Supplied 101+: $0.25 per page Max Fee: $200.00 |
| New Mexico | Copied Pages Supplied 1 – 15: $30.00 flat fee
Copied Pages Supplied 16+: $0.25 per page X-rays: Actual cost of reproduction. |
| New York | Copied Pages Supplied 1+: $0.75 per page
X-rays: Actual cost of reproduction. |
| North Carolina | Copied Pages Supplied 1 – 25: $0.75 per page
Copied Pages Supplied 26 – 100: $0.50 per page Copied Pages Supplied 100+: $0.25 per page Minimum Fee: $10.00 |
| North Dakota | Medical Record Search Fee: $20.00 (Includes Copied Pages Supplied 1-25)
Copied Pages Supplied 26+: $0.75 per page Electronic Records Medical Record Search Fee: $30.00 (Includes Copied Pages Supplied 1-25) Electronic Records Copied Pages Supplied 26+: $0.25 per page |
| Ohio | Medical Record Search Fee: $20.42
Copied Pages Supplied 1 – 10: $1.34 per page Copied Pages Supplied 11 – 50: $0.69 per page Copied Pages Supplied 51+: $0.27 per page X-rays: Medical Record Search Fee plus $2.27 per page |
| Oklahoma | Medical Record Search Fee: $10.00
Copied Pages Supplied 1+: $0.30 per page X-rays: $5.00 per page Max Fee: $200.00 |
| Oregon | Medical Record Search Fee: $30.00 (Includes Copied Pages Supplied 1-10)
Copied Pages Supplied 11-50: $0.50 per page Copied Pages Supplied 51+: $0.25 per page X-rays: Actual cost of reproduction. |
| Pennsylvania | Medical Record Search Fee: $23.45
Copied Pages Supplied 1 – 20: $1.58 per page Copied Pages Supplied 21 – 60: $1.17 per page Copied Pages Supplied 61+: $0.40 per page Microfilm: $23.45 + $2.33 per page |
| Rhode Island | Copied Pages Supplied 1 – 10: $2.50 per page
Copied Pages Supplied 10 – 50: $0.75 per page Copied Pages Supplied 51+: $0.50 per page |
| South Carolina | Medical Record Search Fee: $26.67
Copied Pages Supplied 1 – 30: $0.69 per page Copied Pages Supplied 31+: $0.53 per page Max Fee for Electronic Records: $160.05 |
| South Dakota | No Current Fee Schedule |
| Tennessee | Medical Record Search Fee: $18.00 (Includes Copied Pages Supplied 1 – 5)
Copied Pages Supplied 6 – 50: $0.85 per page Copied Pages Supplied 51 – 250: $0.60 per page Copied Pages Supplied 251+: $0.35 per page |
| Texas | Medical Record Search Fee: $48.77 (Includes Copied Pages Supplied 1 – 10)
Copied Pages Supplied 11 – 60: $1.64 per page Copied Pages Supplied 61 – 400: $0.80 per page Copied Pages Supplied 401+: $0.44 per page |
| Utah | Medical Record Search Fee: $21.16
Copied Pages Supplied 1 – 40: $0.53 per page Copied Pages Supplied 41+: $0.32 per page |
| Vermont | Whichever is greater: $5 or $0.50 per page
Social Security: No charge for a request to support a claim under the social security act. |
| Virginia | Medical Record Search Fee: $20.00
Copied Pages Supplied 1 – 50: $0.50 per page Copied Pages Supplied 51+: $0.25 per page Max Fee: $150.00 Electronic Records Medical Record Search Fee: $20.00 Electronic Records Copied Pages Supplied 1 – 50: $0.37 per page Electronic Records Copied Pages Supplied 51+: $0.18 per page Electronic Records Max Fee: $150.00 Microfilm Medical Record Search Fee: $20.00 Microfilm Copied Pages Supplied 1+: $1.00 per page |
| Washington | Medical Record Search Fee: $26.00
Copied Pages Supplied 1 – 30: $1.17 per page Copied Pages Supplied 31+: $0.88 per page |
| West Virginia | Medical Record Search Fee : $20.00
Copied Pages Supplied 1+ : $0.40 per page Copied Pages Supplied 1+ Electronic Records: $0.20 per page Max Fee Electronic Records: $150 |
| Wisconsin | Medical Record Search Fee: $22.61
Copied Pages Supplied 1 – 25: $1.14 per page Copied Pages Supplied 26 – 50: $0.86 per page Copied Pages Supplied 51 – 100: $0.56 per page Copied Pages Supplied 101+ $0.34 per page Microfilm and other media: $22.19 + $1.68 per page X-rays : $22.19 + $11.28 per series Certification (if not patient or their representative): $9.04 per request |