Rights and responsibilities: Patients, patient representatives, and families
Patient, Family and Visitor Code of Conduct
HIPAA Notice of Privacy Practices
This HIPAA Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this medical information.
Authorization for the Release of Medical Record Information
Please note that different forms are used if you are the patient or if you are the patient representative/guardian making the request, please select the appropriate link.
Authorization for Release and Collection of Patient Information
To allow Boston Children’s Hospital to release information about a patient to, discuss information a patient with, or receive information about a patient from others. This form does NOT allow you to release a certified copy of our medical record.
Health Care Proxy
Patients (age 18 and up) should have a health care proxy on file, so that people know who the patient has chosen to make decisions for them if they are not able to at any point.
Medical Caregiver Delegation
To be used families to delegate care decisions about a patient to someone for a short amount of time (no more than 60 days). Example: Use this form if a grandparent will bring a patient for one or more appointments at Boston Children’s.