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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.
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) Patient Information: Patient Name: __________________________________________Record Number: ______________________________
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.
Meet your privacy obligations under HIPAA with this authorization to release medical information form. Always stay on top of your patient's health concerns, and safeguard their details with ease. Created Date
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.
Download a medical records release (HIPAA) form to authorize healthcare providers to release medical information.
Free immediate download of PDF. A HIPAA release form must be obtained from a patient before their protected health information can be shared for non-standard purposes. It is a HIPAA violation to release medical records without a HIPAA authorization form.