Log InGet a Demo

Medical Release Form Template

Easily send and receive your medical release form template online. Send patients record release forms to fill out on their phone, tablet, or computer. Patients securely sign and submit completed forms directly to your account. Track your patient's progress, send automated appointment reminders, and receive completed medical release forms online.
Get a Demo
Medical Release Form Template

Medical Records Release Form Template

Give your patients the freedom to complete medical release forms with any device, anywhere. Streamline the way you collect signatures and record release forms by setting up your form online.

Easily personalize this release form template with a HIPAA compliant form builder.

Streamline patient forms and engagement

Collect forms. Engage patients. Automate follow-up.

What is the Medical Release Form?

A medical release form permits healthcare professionals to share patient medical records with other parties.

“

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

HHS.gov

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

What is included in medical release forms?

The goal of the medical release form is to protect yourself from potential liability. These are the main items included in release forms. The elements will vary depending on the specific needs of your practice.

01Patient Information

Your medical release form will require the patient’s information, which will include; the patient’s name, phone number, address, email address, date of birth, social security number, and other identifiable information that is relevant. If a parent or guardian needs to release medical information on behalf of their child, the name and signature of the parent or guardian will need to be included as well.

02Receiving Party

Included on the medical release form will be an area for the patient to state who may access their medical records. This will include the names, titles, addresses, and contact information of the receiving party. Have your patients fill out a new medical release form for each receiving party. Using separate forms will enable you to group separate types of patient information with difference receiving parties.

03Patient Information to be Shared

You may have the patient list the types of information that you need to be shared. This may include tests, results, scans, notes, or images. The patient may limit the information that is shared by condition, date, body part and so on.

04Purpose of the Medical Release

The patient will need to indicate why their medical record is being released. Normal options include; insurance claim, medical disability, college immunization, specialist consultation, social security certification, inform child’s nurse at school, and more.

05Expiration of Authorization

This date will give the patient a record of when their release form expires. Typically, medical release forms will have a default expiration of 90 days. However, you may choose whatever expiration date you would like, but 90 days is the standard. This means you will have to request additional authorization of record release forms as they expire, but this will help protect your business by acquiring more written approval.

06Disclaimers

Give your patient information about their rights and how their medical records will be used. You should tell the patient that they are under no obligation to release their medical records and they can revoke their authorization to release at any time. This is also a good place to mention any fees associated with the release of the record.

07Signature and Date

Have your patients e-sign and date the authorization form. Completed medical records release forms will be submitted directly to your account online. Review authorization of record release forms online.

More Online Medical Forms

Streamline your medical forms online. Automate your paperwork. Start saving time and money.
no-surprises-act-form-template-icon

No Surprises Act Template

Send your patients your practices No Surprises Act notice, quickly and easily online.
Patient Intake Form Template

Patient Intake Form

Easily have patients complete your patient intake forms online. Completed patient intake forms are submitted securely to your account, before the patient's appointment.
Telemedicine Consent Form Template

Telemedicine Consent Form

Easily have patients complete your HIPAA compliant telemedicine consent form with their phone, tablet, or computer. Make it easy for patients to complete your consent forms online.
Patient Satisfcation Survey Template

Patient Satisfaction Survey

Follow up with your patients by sending this patient satisfaction survey. Your patients are your customers and patient satisfaction is critical to ensuring the success of your practice.
grief-evaluation-form-template

Grief Evaluation for Children & Teenagers (17 and Under)

Collect valuable information concerning your patient’s grief experience and daily life. Review this information prior to the appointment to guide the conversation.
COVID-19 Screening Form Template

COVID-19 Screening Form

Send patients COVID-19 screening forms to fill out on their phone, tablet, or computer. Safely screen patients for COVID-19 by enabling them to fill out forms on their own device.
phq9-form-template-icon

Patient Health Questionnaire (PHQ-9)

Give your patients the freedom to complete the PHQ-9 from any device, anywhere. Ensure privacy and help keep teens safe by ensuring completion of this screening form before their clinic visit.
Medical History Form Template

Medical History Form

Turn your paper medical history forms into HIPAA compliant online forms. Streamline your forms by removing the paperwork. Collect a more accurate medical history from your patients.

Streamline patient forms and engagement

Collect forms. Engage patients. Automate follow-up.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Save and Continue Later

Save and Continue Later

Allow patients to save their progress on larger forms and packets. Patients will be able to resume where they left off and finish completing your forms at a later time.

Conditional Logic

Conditional Logic Forms

Only show information that is relevant to the patient with conditional logic forms. Make it simple for your patients to complete your forms and improve the accuracy of the data you receive with conditional logic.

HIPAA Compliant Submission Audit Logs

Submission Audit Logs

Form submissions have a detailed history that can always be referenced. Audit logs cannot be changed and the history from all users is tracked.

Print HIPAA Compliant Submissions

Print HIPAA Compliant Form Submissions

Print your patients’ submissions after the forms have been completed online. Adjust the formatting and text size to match your original paper forms.

View More Features

Book a Free Demo

Schedule a demo to see how FormDoctor can streamline patient forms and automate engagement.
Schedule a Demo

FormDoctor gives your practice one HIPAA-compliant platform to collect forms, communicate with patients, and automate follow-up. We help practices who:

  • Are still using paper forms, PDFs, or Word documents
  • Spend too much time printing, scanning, emailing, and calling patients
  • Need an easier way to send reminders and automate follow-ups
  • Want to streamline forms, communication, and paper workflows