Medical Records Release Form Template

Available on the Free Plan

Are you looking for more efficient ways to obtain permission from patients to release their medical records? Use this form template.

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About this template

As healthcare providers, you’re always looking for more efficient and modern ways to obtain permission from patients to release their medical records. Yes, you can let go of the paperwork and use our medical records release form template to safely collect and store your patients’ authorization to share their health information or history. Our form builder has all the needed security measures that ensure you collect medical records and release requests safely, including HIPAA-compliance if required for your health organization.

Frequently Asked Questions

What is an authorization to release medical records?

An authorization to release medical records is when the patient fills out a form or signs a document giving the healthcare organization permission to share their medical information with a 3rd party organization.

What information should a medical record release form include?

A medical record release form is a legal document containing sensitive information that should be collected properly and safely, both possible with 123FormBuilder.
To make sure there’s a clear understanding of what medical data can be shared, here’s what you should include in a medical record release form.
1. The patient’s personal and contact details.
2. The healthcare organization releasing the information and the one receiving it
3. The specific medical record being shared
4. How will the information be shared
5. Terms and conditions that apply
6. Digital signature

Customize template

Medical records release requests should be concise, clear and clean. This ready-made template saves you a lot of time and is easy to modify without writing any code. Drag & drop additional fields if you need to, add your medical facility logo and make use of the conditional logic option. Use a reCaptcha, secure submissions and enable form password protection.

Publish template

Our medical records release template is mobile-responsive and can be accessed from any device. When you are satisfied with the look and contents of your records release form, you can hit the Publish tab in your editor and have your form easily embedded on your website. Only a copy paste is required from your part.

Collect & manage data

Handling confidential healthcare information is a big responsibility. Submissions on the medical records release form are streamlined over a secure SSL connection and stored in an encrypted repository. Upon request, you can upgrade your 123FormBuilder account to create HIPAA-compliant forms. Data entries can be exported in CSV, Excel or PDF, and also connected to Google Drive and other third-party apps of your choice.

Optimize processes

Forget the paper form mess. Speed up the data collection process with email or SMS alerts each time someone completes the form. Create beautiful and functional medical forms online using 123FormBuilder premade templates.

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