HIPAA Release Form Florida

HIPAA Release Form Florida

Florida Medical Records Release Form with HIPAA Compliance

    HIPAA
    Compliance
    Checklist

    Simple Guidelines
    Immediate PDF Download

    Immediate Access

    Privacy Policy

    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.

    What is a HIPAA form?

    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