Medical Authorization Form (With Examples)

5 min read

It is common for one to request permission from individuals, organizations, or other entities before doing something on their behalf or something that could impact their privacy. Just like you would request your friend for permission before taking their car or eating their lunch, the same goes for medical situations; however, for medical situations, you will have to do this through the use of authorization forms and not just verbally.

Basically, an authorization form shows that all the parties have agreed and have permitted the other to act on their behalf or continue with their intentions. Authorization forms can also serve as legal tenders in courts of law. More likely than that, you will, in most cases, be required to produce an authorization form in various instances before being allowed to proceed with certain activities; hence, why you need to understand what an authorization form if, what it entails, what happens when you fill one out, and how to come up with one that will be effective enough.

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What is a Medical Authorization Form?

A medical authorization form is a form from the patient to a third party, permitting them to access your protected medical records. The form can either be limited in scope or can be as broad as granting access to the third parties to anything in your medical records.

There are various reasons why you would want to permit someone to access your personal medical information.

If you are a patient, you will have to authorize your doctor, the hospital, or health care provider access to your records. The parties you have authorized may then need your consent to share such information with other parties.

For example, you may want to grant your attorney access to your medical records to prove that your injury wasn’t pre-existing if you are pursuing an injury claim. You may also want to permit your health care agent to question your doctors or healthcare practitioners about a bill if you are hospitalized or incapacitated.

The other reason why you may want to have used a medical authorization form is when you are sick and the medicine or procedure that the doctors are still in the trial phases. Since the doctors are not entirely sure of whether the medicine or procedure works 100%, they will have to seek your consent in order to proceed.

When is a Medical Authorization Form Needed?

There are several instances where your doctor may require you to sign a medical authorization form, including:

  • When you severely sick and the doctors would like to inform your family members of your sickness
  • When the doctors have to perform a medical procedure on you
  • When the doctors are looking to share your medical information with other parties
  • When the doctors are looking to use a trial medicine or vaccine on you as a test subject

To be safe from litigations, doctors/hospitals will require their patients, if severally sick, to sign a medical authorization form before proceeding with their treatment at the facility.

When Do You Need it?

There are three main reasons why a patient may be required to sign a medical authorization form by their doctors before any treatment can commence;

  • If or when the results of a medical procedure are uncertain, even in cases where the operation is essential
  • If the doctors, hospital, or health care providers can not share the patient’s medical records without their consent, i.e., if sharing of such information is illegal
  • Suppose the patient requires emergency treatment. They must first sign a consent form before the doctors can proceed with the treatment.
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What is Included in Medical Authorization Form

  1. Title: This is the tile of the medical authorization form. This can be something like “Medical authorization form for release of medical records”.
  2. Statement of purpose: What is the medical authorization form for? What have you authorized the doctors to do and why?
  3. Patients information: This includes the patients’ name, address, phone number, age, social security number, and any other identifying information that may be valuable
  4. Receiving party information: this includes the name of the receiving party, their badge number, or any other identifying information
  5. List of relevant medical information: is it a medical procedure? Is it a trial medicine being administered? This list should contain all the necessary information to help specify what the medical authorization form is for.
  6. Patient signature: The patient must sign the document to show that they have read and understood what they agree to.
  7. Clear expiration date: For how long is the authorization form valid? A medical authorization form must have a clear section detailing how long the parties have been granted access to the medical records. This field enables the patient to record a date when the authorization form expires.
  8. Disclaimer: A medical authorization form should have a disclaimer stating that the information once shared is no longer protected and can be disclosed to other parties. Also, if it is an authorization for a medical procedure, the disclaimer should state that the patient has agreed to the procedure and anything that may happen due to the procedure is not to be blamed on the doctors or the hospital.
  9. Power of Attorney: The Power of Attorney permits the doctor to act or elect someone to act on the patient’s behalf if they are incapacitated or unable to do so. The form must have this provision to show that the patient has enacted the power of Attorney the medical practitioners.
  10. Supporting documentation: The medical authorization form should be accompanied by other supporting documents such as the identification documents of all the parties mentioned in the form, i.e., their identity cards and any other documents that can be used to identify them with ease.
  11. Date and signature: the form must have the date of authorization and have the patient’s signature to show that they acknowledge the document.

How To Write a Medical Authorization

Step 1: Download the medical authorization form to your computer

Step 2: Fill in all the information as directed

Step 3: Write the parties that you have authorized to use the information or gain access to your medical records

Step 4: Write down the type of information that you have authorized the party to use or dispense/ write down what you have authorized the doctors to do

Step 5: discuss your reason for drafting the authorization form

Step 6: Sign the authorization form and also have the parties mentioned sign to acknowledge the document if possible

Step 7: list down any sensitive items that may be authorized at the patients’ disposal

Step 8: Add any supporting documents that are required for the authorization

Medical Authorization Forms & Templates

Coming up with a comprehensive medical authorization form can be a tough job for many. With all the details required to make sure that all the areas are covered, the chances are that you will leave out some crucial information. Download our ready to use medical authorization templates today to help you out.

Advocate-Medical-Authorization-Form_

California-Medical-Authorization-Form

Cigna-Medical-Authorization-Form_

Day-Care-Medical-Authorization-Form_

DC-Medical-Authorization-Form_

Emergency-Medical-Authorization-Form_

Employer-Medical-Authorization-Form

Florida-Medical-Authorization-Form_

Generic-Medical-Consent-Form_

Grandparent-Medical-Authorization-Form

HIPAA-Medical-Authorization-Form_

Legal-Medical-Authorization-Form_

Medical-Consent-Form-for-Babysitter

Medical-Consent-Form-for-Caregiver_

Medical-Disclosure-Authorization-Form_

Medical-Emergency-Consent-Form_

    Conclusion

    Medical authorization forms are important forms in the medical field. And this is why the medical personnel usually takes it more seriously. It is important to have the patients sign a medical authorization form before any treatments or procedure to protect yourself from any litigation that may arise afterward. We hope that this guide has provided you with all the information that you need to get started on your medical authorization form.  

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