10+ Best Medical Release Form Examples & Templates [Download Now]


We are currently living in an era where information is a commodity. Through the internet, we can get the information that we need to get things done. From a traditional classroom setting, education has evolved to a whole new level. We can now enroll and take online courses to learn the skills that we need to improve our lives. We are indeed in an information age. From communication to the field of e-commerce, the internet has been advancing to serve its purpose.

However, along with these beneficial things that we are getting, this advancement also allows the wrong people to take advantage of the high level of information availability. Hackers and other individuals infiltrate systems and databases to steal confidential information such as credit cards and health care details. These populations use this information for their gain. According to the article posted in cisecurity, data breach incidents in health sectors have jeopardized fifteen million health records. To mitigate the daunting effect of the data breach, health sectors implement strict security measures in accessing and providing information from their firm’s database that their employees can follow. The customers have a say to let other organizations and individuals gain access to their health information through a medical release form. These people may include direct family members, such as grandparents, parents, siblings, or children.

What Is a Medical Release Form?

Through a medical release form, individuals can limit the people who have access to their health information. This release form will allow you to gain access to your customers’ and patients’ health information if they avail of your services. As a healthcare specialist, you must obtain this authorization following the Health Insurance Portability and Accountability Act(HIPAA) before you can adequately provide medical treatment or get your clients’ and patients’ health information.

10+ Best Medical Release Form Examples & Templates

Now that you already know what a medical release form is and what it is for, the next step that you are going to make is looking for the best design that you can use to create the right release form that suits your organization’s needs. That’s why we created a list of the best examples and templates of release forms that you can check and select from. These templates will save you from the hassling task of browsing for best model from the haystack. To help you further, we also included a set of instructions on how to create a medical release form for your business in the next section.

1. Blank Authorization for Release of Medical Records

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  • PDF

Size: 459 KB

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2. Printable Medical Authorization and Release

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  • PDF

Size: 8 KB

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3. Universal Patient Authorization Form

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  • PDF

Size: 142 KB

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4. Authorization to Release Copies of A Medical Record

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  • PDF

Size: 157 KB

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5. Privacy Authorization Form

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  • PDF

Size: 497 KB

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6. Generic Authoriztion for Release of Health Information Pursuant

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  • PDF

Size: 65 KB

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7. Compliant Authorization for the Release of Patient Information

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  • PDF

Size: 14 KB

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8. Authorization for Release of Health Information

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  • PDF

Size: 249 KB

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9. Authorization for Disclosure of Medical or Dental Informationn

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  • PDF

Size: 54 KB

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10. Authorization for Use or Disclosure of Patient Health Information

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  • PDF

Size: 157 KB

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11. Authorization to Disclose Protected Health or Billing Information

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  • PDF

Size: 364 KB

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Why Obtain Your Own Medical Release Form?

By letting your patients sign a medical release form, you are authorized to access the necessary information to serve your business goals. There are many available templates that you can download from the internet for your medical release form. The patients can also create this type of structure themselves. However, it can be essential to customize it according to what your company needs. Thus, you can exclude the unimportant fields that your clients will find useless. It will also relieve the burden that the clients would have felt in writing this type of document. Thus, it will give them a good impression of your company.

How to Create the Best Medical Release Form for your Firm?

Without further ado, to create an excellent medical release form for your firm, read the following instructions.

1. Look for an Initial Outline for Your Structure

Picture out how your outline should look. You can come up with one framework that you can use for a specific category or service and write it on a word processor. For more ideas on how to outline your form, you can refer to the examples that we have provided above.

2. Figure out the Necessary Fields for the Document

Once you have chosen the right outline for your form, you can now put the fields for the patient information. This information includes the patient’s name, birth date, address, phone number, date, signature, etc. To avoid mistakes in terms of spelling, you should set a meeting with your customer or find a communication medium where you can effectively obtain the correct information for the form.

3. Include the Authorization or Permission for Your Company to Access Specific Information

In this step, you will have to write an authorization letter from the customer’s perspective. The document should state that the customer permits your organization to access specific information that the health sector holds. You will include information such as the purpose, effectivity period, etc. Don’t forget to include fields for the customer’s and guardian’s signature.

4. Proofread the Contents

Once you have added all the required information, you will, then, check for grammar errors and other mistakes. You have to remember that even minimal mistakes, such as minor grammar errors, can lead to misunderstanding. You can also check the words that are overflowing from the given fields and spaces. You don’t want to leave a few objects in an awkward position. By proofreading, you will also maintain the professionalism of your firm.

5. Have the Patient Sign the Printed Document

Lastly, after ensuring that the document is error-free, you can now give it to your patient to sign. Give him enough time to go over the printed material, though. This document is very crucial, so the patient must clearly understand and agree to the agreement you wrote before signing.

While it is true that new technology advancements intend to make our life easier, unwanted consequences can also come along with it. However, our goal is still there, so as humans, we find ways to mitigate these consequences. The health sectors have come up with a solution to avoid compromising patients’ and clients’ health information compromisation. That is through the medical release form. With the information we provided through this article, you now know the importance of this document to your company. You should also now have an idea of how to obtain one.

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