Current Environment:

Warning

Recall Alert

There is a voluntary recall. Learn more

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.

Read about privacy practices

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.

Download authorization for release of medical record info

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. 
 

Authorization for release, collection of patient info

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.

See healthcare proxy form

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.

See form for medical caregiver delegation