Who is authorized to sign for the release of information to obtain a copy of the medical record?
The following individuals may sign the authorization for release of medical information:

• The patient
• The parent or legal guardian
• If patient is deceased, the next of kin may sign for the patient with identification. A copy of the death certificate along with either court documents stating that they are the executor of the estate or they must complete an authorized relative certification.
• If patient is unable to sign for their records, the person requesting the records must provide a healthcare power of attorney. A spouse or domestic partner may not request medical records without the patient's consent.
• All requests for behavioral health records require specific authorization and a witness signature. If patient is under 12 years of age, a parent or legal guardian can sign for the release of medical records. If patient is between 12 years of age or older, the patient must sign for their own records.

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1. Who is authorized to sign for the release of information to obtain a copy of the medical record?
2. How much does it cost to obtain a copy of my medical record?
3. When will I receive a copy of my medical record?
4. Who should I contact if I have questions?
5. How do I file a complaint regarding the privacy of my health information?