Sample Forms for Release of Information or Records
These sample forms can be used for release of information or release of records. Please note the following before using these forms:
- These are compliant with either FERPA (Family Educational Rights and Privacy
Act) for education records or HIPAA and CMIA (Health Insurance Portability and
Accountability Act and California Confidentiality of Medical Information Act) for
- Do not use these forms for release of information or records that may be subject
to other confidentiality laws, such as certain drug treatment, mental health and
special education records.
- All forms can and often should be adapted to meet specific needs of a program.
- All forms should be reviewed by legal counsel before use.
- These are not consent to treatment forms.
Hear case studies and see how to use our updated California Guide for Sharing Student Health and Education Information.
FERPA Web Resources
HIPAA Web Resources
Federal and State Codes
- Minor Consent Laws
- Joint Guidance on the Application of FERPA and HIPAA
- EDC's Promote Prevent Information Sharing
- Rules for Exchanging Behavioral Health Information in California
- State Health Information Guidance (SHIG) on Sharing Behavioral Health Information
- Coordination of Services Team Guide - Alameda County