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TO REQUEST RELEASE OF MEDICAL INFORMATION PLEASE COMPLETE AND SIGN THIS FORM. I, ____________________________________hereby voluntarily authorize the disclosure of information from my health record. (Name of Patient)
A medical records release authorization form is a document that allows a person to disclose protected health information to a third party. A patient can also request their medical records not currently in their possession.
The medical record information release (HIPAA) form allows patients to give authorization to a 3rd party and access their health records. It also allows the added option for healthcare providers to share information. Powers granted under a medical release can be revoked or reassigned at any time.
Download a medical records release (HIPAA) form to authorize healthcare providers to release medical information.
This form is for use when such authorization is required and complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Standards.
A Medical Release Form is a crucial document that authorizes healthcare providers to disclose your medical records. It serves two primary purposes: ensuring your privacy and facilitating continuity of care.
I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription history clearing house, consumer reporting agency, employer, or family member to release (Check one) ☐ all health