HIPAA Forms
Privacy authorization and consent documents for patient advocacy services.
StartHere Patient Advocacy is committed to protecting your health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA). The forms below authorize our advocates to communicate with your care team and access information needed to support you.
Required Forms
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Download FormHIPAA Authorization for Release of InformationAuthorizes healthcare providers to share your protected health information with StartHere.
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Download PDFPatient Advocate Services AgreementOutlines the scope of advocacy services and your rights as a client.
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Download PDFNotice of Privacy PracticesDescribes how we use, disclose, and safeguard your health information.
How to Submit
Download, complete, and sign the required forms. You may return them by email, mail, or in person at your first advocate visit. If you have questions about any form, contact us before signing.
Note: HIPAA is the correct spelling of the federal privacy law. Forms labeled "HIPPA" elsewhere may refer to the same requirements — we use the standard HIPAA terminology on this site.