AHIMA Releases Standardized Patient Request for Information Form

Requesting one’s health information is among the most confusing medical endeavors for consumers, since laws can vary by state and even trained release of information (ROI) professionals may not be aware of the latest government guidance. AHIMA has been working on a way to streamline this process and reduce uncertainty for health information management (HIM) professionals and consumers. The result of that work was unveiled this week with the release of AHIMA’s Patient Request for Health Information Form.

The model form is intended to help providers streamline patient health information request processes and ensure they are compliant with the Office for Civil Rights’ (OCR) guidance on an individual’s right of access under the Health Insurance Portability and Accountability Act (HIPAA). In January 2016, OCR released interpretive guidance, titled “Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524,” which outlines the patient’s right to obtain their personal health information and clarifies the responsibilities of healthcare providers to comply with the HIPAA Privacy Rule. The updated guidance addressed the patient’s right to inspect and/or obtain a copy of their health records and to have a copy of their records sent or directed to an individual of their choosing.

The AHIMA-developed form is meant to be used as a template that providers can tweak to meet their needs, and then given to patients or their designated personal representative when they’ve requested access to their health records.

“Many patients may not understand their rights to access their personal health information including that they can request to receive information in a format of their choosing, such as on a jump drive or through e-mail. There also remains some confusion by healthcare professionals regarding their responsibility to provide patients with easy access to their records,” said AHIMA interim CEO Pamela Lane, MS, RHIA. “Written in easy-to-understand language for all patients, this model form and explanation of use provides healthcare providers with a customizable tool that both ensures their compliance and captures patient request information in a clear, simple format.”

Recommendations for using the Patient Request for Health Information Model Form include:

  • Organizations should edit the form based on system capabilities as well as operational needs.
  • Organizations should read and understand the OCR guidance, 45 CFR 164.524(c)(3), to ensure compliance.
  • Organizations are not precluded from developing their own internal policies that comply with the OCR guidance as long as they do not create barriers to patient access. For example, if a patient requests health information be transmitted through unsecured e-mail, the provider should comply.
  • Logo, barcode, and address may be added to the form at the organization’s discretion.
  • OCR guidance and state laws should be consulted when developing an organization’s fee structure.

For more information and to download a copy of the form visit: http://www.ahima.org/modelform.

Mary Butler is the associate editor at The Journal of AHIMA.


  1. I need my medical records both from Rochester and UNM.

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  2. I have tried to download a copy of the model form – Patient Request for Information from July 2017 Journal of AHIMA article but I get a message that states that I am not authorized to view the form. Can you help me obtain a copy of this form? I am a member of AHIMA.

    Post a Reply
    • Hi Cynthia,

      I recommend contacting AHIMA’s customer relations department. They should be able to assist.

      Thank you

      Post a Reply


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