Authorization Forms

Authorization for the Release of Medical Record Information

Please note: Different forms are required depending on whether you are the patient or a representative/guardian.

Authorization for Release and Collection of Patient Information

This form allows Boston Children’s Hospital to share, discuss, or receive information about a patient with others. It does not authorize the release of a certified copy of the medical record.

HealthCare Proxy

Patients aged 18 and older should have a healthcare proxy on file to ensure others know who can make medical decisions on their behalf if they become unable to do so.

Medical Caregiver Delegation

This form allows families to temporarily delegate care decisions for a patient—up to 60 days. For example, use it if a grandparent is bringing the patient to one or more appointments at Boston Children’s.

What You Need To Know

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Rights & Responsibilities

Understand your rights and responsibilities as patients, patient representatives, and families.

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HIPAA Notice of Privacy Practices

This notice explains how your medical information may be used, shared, and how you can access it.

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Employee Code of Conduct & Compliance

This manual reflects our core values and guides our strategic and operational decisions.

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Website Terms of Use
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Website Privacy Policy