Medical Information Release Form

Medical Information Release Form

The creation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) aims for four goals. It aims to assure health assurance portability, reduce health insurance fraud, enforce standards for health information, and guarantee the safety and privacy of healthcare information. As a measure to effectively uphold the fourth purpose, the use of medical information release forms is enforced. This form is necessary when it comes to the disclosure and exchange of an individual’s medical history, which includes diagnosis and treatment. Read More

What Is a Medical Information Release Form?

In the medical field, the accuracy of information from one source to another is critical. The specifics of the diagnosis and treatment should be accurate to uphold the goal of saving more lives. In the process of exchanging details about a patient, a medical information release form is necessary. If the physician decides that they need an expert opinion from a colleague, this form must be signed by the patient before their physician can share their details with another professional. A medical information release form is similar to a patient’s written consent. Moreover, it can also serve as an authorization letter if a third party needs to acquire the medical record for other purposes.

How Do You Create a Medical Information Release Form?

The contents of a medical information release form must abide by the privacy policies established by the HIPAA. This document must carry out the goal of the act. Thus, it is important to well-structured release form. If you want to avoid the hassle of creating it from scratch, our site offers downloadable ready-made medical information release forms. On the other hand, if you want to make one from scratch, you can follow these steps and tips to create a professional release form.

1. Identify the Patient

The writer of a medical information release form must be the patient, the subject of the medical records. Understandably, the first part of the form must present the information of the writer. It only requires the patient’s name, date of birth, and patient’s social security number. Asking for the person’s SSN is an additional measure to verify their identity to avoid possible fraudulent activities.

2. Identify the Recipient

The nature of the need for this form is to allow the exchange of sensitive information. Following this idea, the details of the recipient of the information must also be disclosed in the form. Whether the medical records are forwarded to another physician or healthcare institution, their vital information must be present. Moreover, these details will help in tracking who holds a copy of a person’s medical history and where it is.

3. State the Purpose of the Authorization

After identifying the involved parties, the reason for the release of the sensitive information and subsequent authorization must be stated. The statement presenting the reason must be clear to set the limits of what the receiving party can do with the information. Apart from sharing the information with other professionals, requesting for the release of these details can be for personal reasons or for healthcare insurance reasons. Whatever the reason may be, the writer of the form must present this reason in a concise yet comprehensive manner.

4. Know Your Rights

Aside from stating the intention to release particular information, a medical information release form also has stipulations announcing and protecting the rights of the patient. These rights set the parameters of what the patient can and cannot do. One example states that the patient has the right to revoke the authorization but it does not have a retroactive effect. This means that once the authorization is revoked, the decisions done by the representative cannot be undone.

5. Check the Need for Additional Consent

If the medical records contain sensitive information that the patient may have second thoughts about sharing, additional consent is necessary. The latter part of the form presents these additional consents if ever necessary. Additional consent is required when sharing information about abuse, mental health treatment, and drug dependence among others. When it comes to disclosing details regarding HIV or AIDS, additional review and consent are also required. The patient has all the right not to agree to share these even if the purpose is for second opinion or verification.


Who can sign the form for a deceased patient?

In cases where the patient already died before signing the document, a personal representative of the patient can sign the form. As for minors and patients who are unable to sign, their parents or legal guardians must sign the document in their stead.

Do all doctors have access to their patients’ medical records?

Following the HIPAA standards, the doctors must have the consent of their patients to share their information with other healthcare practitioners. Thus, doctors do not have the entire record of their patients without their consent. Also, some patients choose to hide some information regarding their medical history.

Are there different kinds of medical records?

There are two known medical records. These are the source-oriented records and problem-oriented medical records. Information from both types of records can be disclosed by using the medical information release form.

Who owns my medical records?

The actual owner of your medical records is the physician who created it. Aside from the physician, the facility where the record was created also owns the record. This type of ownership is the reason why the patient receives a copy of their entire medical history but not the original copy.

Can I choose to delete a part of my medical history?

Using this medical information release form, you cannot delete a segment of your medical history but you can choose not to disclose it to whoever is the recipient. Deleting a part of your medical record is only possible if this detail is proven to be false by medical professionals. However, this particular detail will only be deleted from the paper copy and not from the electronic record.

A person’s medical record is the profile of their medical history, current diagnosis, treatment, and everything related to a person’s wellbeing. Even if it made up of critical information, its disclosure and exchange must be controlled to ensure that it will be used to uphold the goal of the health care industry. Thus, a medical information release form is a critical document in keeping the disclosure of these details in check.