A Release Form is a document used to release a company or institution from any legal liabilities. The party that gives up the right to sue is called the releasor, and the individual being released from future claims or legal liabilities is the releasee. A lot of industries make use of Release Forms, and the healthcare industry is not an exception. A Release Form is a lot like a Consent Form, where the patient can give consent to release his medical records to authorized persons, a parent or guardian can give consent for his underage child to get medical treatment when necessary, and so many other functions.

Patient Medical Release Forms

Medical Release Form in PDF

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Printable Medical Release Form

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Medical Information Release Form

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Medical Records Release Form

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Patient Release Form Samples

Sample Medical Release Form

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Free Sample Talent Release Form

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HIPAA Release Form Sample

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Patient Release Forms and Why They Are Important

Any establishment or institution is not allowed to release the information of their constituents without their consent, as this would be a violation of their right to privacy. A medical institution is not an exception to that rule. They need Patient Release Forms to make sure that they are legally protected prior to performing a task as stated on the Patient Release Form, such as releasing a patient’s medical records, posting a patient’s testimony of the hospital and a patient’s photo for marketing purposes, and acquiring consent for an underage patients to get medical treatment. You may see our Hospital Release Forms for other downloadable samples.

The HIPAA or the Health Insurance Portability and Accountability Act of 1996 is also one of the reasons why Patients Release Forms are important. Under this act passed by Congress, there is a privacy rule, wherein any covered entities are not allowed to disclose Patient Health Information without written authorization from the patient, or that would be the Patient Release Form, unless it falls under the exceptions. You may see our HIPAA Release Forms for more samples and information.

What Information Should Be under Patient Health Information?

This includes any information that has to do with the patient’s medical treatment, health history, and family history, among other things. The definition of Patient Health Information is pretty broad, but basically it is any information that pertains to the patient’s medical records. That would be a patient’s health status, payment of healthcare, and healthcare provisions that can be linked to an individual.

Who Are the Entities Covered under HIPAA?

Covered entities include any healthcare provider, employer-sponsored health plans, healthcare clearinghouses, and health insurance providers. It also includes any third party company or independent contractors of the aforementioned covered entities that fit into the description of business associates.

What Circumstances Are Exempted under HIPAA?

Generally, if the covered entity does not have a Patient Release Form to document that they were duly authorized to release a patient’s health information, they cannot do so. But like any other rules, there are always exemptions, especially if it would then involve the safety of an individual or the general public. For example, a hospital may be required by law to disclose a minor’s health information to state child welfare agencies for suspected child abuse.

They may also release a patient’s protected health information to law enforcement officers for law enforcement purposes, such as court orders and subpoenas, and administrative purposes and requests. It could also be to identify a fugitive or a suspect, or a witness, and to locate missing persons. In such cases, since it is a matter of protecting the safety of the general public and the concern is more grave than protecting a person’s right to privacy, the covered entities may disclose protected patient health information even without the patient’s consent or authorization. You may also see our Medical Release of Information Forms for more downloadable samples and information.

Patient Information Release Forms

Information Release Form Sample

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Sample Authorization to Release Information Form

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Consent to Release Information Form

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Information Release Request Form

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Patient Records Release Forms

Medical Records Release Request Form

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Medical Records Release Authorization Form

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Dental Records Release Form

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Types of Patient Release Forms

Although there are various types of Patient Release Forms for different uses, there are two main types. That would be the Medical Records Release Forms and the Minor Medical Release Forms. Let us start with the former.

Medical Records Release Form

A Medical Records Release Form is a document used by medical facilities and other covered entities in compliance with the HIPAA. A patient who wishes to get a copy of his medical records or wishes to have another individual or entity have access to his medical records may fill this out and submit it. A Medical Records Release Form has to include the who, what, why, how, when, and where.

Information to Be Included in a Medical Records Release Form

  • There should be an explicit statement that the releasor authorizes the releasee to disclose his health information.
  • The names of both parties, the releasor, and the releasee should be stated as well.
  • The name/s of the recipient of the health information should also be properly stated, so that the information will not be disclosed to individuals that are not specifically stated on the Release Form. This could be another healthcare provider or an employer, among other things.
  • The patient health information that should be disclosed would also have to be specified. This should be as specific as possible and understandable, to avoid any confusion and misunderstanding.
  • Just like any other Release Forms, the expiration should also be stipulated. This will properly outline the amount of time the releasee has to disclose the specified information. This could range from 30 days to 90 days.
  • It should also be stated that the patient has the right to revoke his or her authorization at any time.
  • In addition to that, it should be stated if there are any consequences should the patient refuse the disclosure, or if there are any benefits and medical treatment that are dependent on the disclosure of the patient’s health information.
  • The purpose of the disclosure of the patient’s health information should also be included, whether it is for employment purposes or to get medical treatment.
  • Lastly, the date and the patient or the releasor’s signature should also be included. If it will be signed by an authorized representative, there should also be a description of said authorized representative included in the form. For this, you may see our Medical Authorization Forms for more downloadable samples.

Patient Testimonial Release Forms

Testimonial and Photo Release Form

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Free Patient Testimonial Release Form

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Patient Consent Form

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Patient Authorization Form to Release Information

Authorization for Release of Information Form Sample

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Patient Photo Release Form

Standard Photo Release Form

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Patient HIPAA Release Form

HIPAA Information Release Form

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HIPAA Compliant Authorization for Release of Patient Information Form

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Medical Information Release Forms

Authorization for Release of Medical Information Form

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Patient Information and Medical Release Form in PDF

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Common Purposes for Medical Records Release Forms

  • Health insurance companies need access to an individual’s medical information to draft life and health insurance policies, pay health insurance claims and workers’ compensation claims. This is because a person’s medical information, especially his medical history, will be taken into consideration when making these decisions. You may also see our Health Insurance Forms for samples that are easy to download and understand.
  • Whenever a patient will be referred or transferred to another medical facility for continued treatment, or if he just switches to another medical service provider, the new medical provider will want to review the patient’s medical history. This is so that they can provide a continued and better medical treatment for the patient based on his medical history.
  • If a patient would take legal action, such as in personal injury cases and medical malpractice cases, the patient’s medical records would have to be accessed to provide proof of physical injury, determine the cause of the physical injuries, calculate the damages, and review the details to determine whether the health provider provided proper medical treatment and reasonable care to the patient.
  • Medical Records Release Forms are also used for employment purposes. The employers would access a potential employee’s medical records to make sure that he is physically fit enough for the requirements of the job, because it is not just the employee’s skills that would have to be looked into. Also, it is necessary for employers to document sick leaves filed by their employees. For this, you may see our Employee Health Forms for your other employee health needs. You may use them as basis for your own forms.
  • Medical Records Release Forms can also be used for research purposes, such as in clinical trials and medical studies. They need to have access to medical records for these.

Minor Medical Release Forms

These are used for parents or guardians of an underage or minor child to provide their consent or authorization to an educational institution or any other organization, for their child to receive medical treatment when necessary, if they cannot be contacted. You may also use our Travel Consent Forms when your child is going to be travelling alone, with one parent only, or with another adult.

Information Included in Minor Medical Release Forms

  • There should be a statement that the parents or guardian authorize the temporary guardian (a school, a babysitter, or a sports organization) for the child to get medical treatment in case of a medical emergency, in the situation wherein the temporary guardian cannot contact the parents or guardians after all efforts have been exhausted.
  • The names of the parents or guardians, and the temporary guardians should be included, along with their other personal details like addresses and contact numbers. The name of the child in question also has to be included.
  • The child’s medical history should also be included to aid in administering medical treatment. Such medical history includes any known allergies to medication or food, any present or previous health conditions, history of vaccines, and a list of current medications being taken.
  • The allowed medical treatments should be included as well, along with the preferred medical facility and physician, and any health insurance information.
  • The date and signature of both parents and guardians to make the form official.

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