Your medical records are confidential, a part of your private life, and are considered “protected health information, or PHI. The HIPAA, or Health Insurance Portability and Accountability Act, was created to protect patients private medical records. In order to pass on your medical information you must authorize it by utilizing a medical records release form. Medical records release forms are forms that give a set of permissions to people in certain situations, to allow a clinic, hospital or medical professional to release medical records.
Basic Elements of a Medical Records Release Form
Medical records release forms have certain elements which need to be included in order to meet the HIPAA medical privacy rules. When you compose a medical records release form, or download one online, make sure it has the basic elements which include:
- An explicit opening statement which states the intent to release confidential health information, or PHI to an organization or medical professional.
- What type of health information will be disclosed
- Who will disclose the medical information
- Who will receive the medical information
- What is the purpose or reason for the release of medical information
- Important names, addresses, dates and signatures
There are two basic types of medical release forms. The first form is a medical history release form. In this case, a form which lets a medical professional see your medical records. The second medical release form involves granting permission to administer medical care to a dependent if they are away from home. The following section attempts to give you a bit of a background in the medical records release form, and helps explain the important parts of basic medical release forms.
Medical History Release Form
This is quite simple to do, as you are simply granting a medical professional or hospital the permission to look at your medical history that are from another doctor or clinic. This is necessary because it is illegal for any doctor to have access to your medical history without you allowing it.
The information you’ll need for this document is your birth date, social security number and include any name changes. For example, if you were not married at the time, you’d include your maiden name. Next, state these words “I [NAME], authorize the release of my complete medical records and history to [MEDICAL PROFESSIONAL/CLINIC NAME]. At this point you can be more specific, for example, include only a medical condition or your complete medical history, what medical information you wish to be shared, the purpose of the medical records release and recipients information. Be sure to go over the basic elements of composing a medical release form document we have listed above.
Finally, remember to protect your privacy, and set the date. If you have any medical history information that you do not want released, you must create a section on the document where you state this plainly. You must also relate how long this release form is to be active, an expiration date if you will. Whether you want it active for 60 or 90 days, you must list the current date, and state that it is to be valid for about 60 days, and complete it by doing a standard signature and date.
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Medical History Release Form Templates
Sample Medical Record Release Form
Sample Release of Information Form
Sample Patient Medical Records Release Form
Sample Medical Record Release Request Form
Medical Release Form Template Word
Standard Medical Records Release Form
Medical Records Release Form
Free Printable Medical Forms
Dependent Medical Release Form
This type of medical release form is designed to give a caregiver, or other named individuals the permission to administer medical treatment to a dependent, such as a child, disabled or elderly individual when they are away from home. There may be a time, when your phone’s battery runs out, or any other reason where you cannot be reached, and this form gives others the permission to do what they can. In this way the caregiver is given legal protection in the event something goes wrong. Again, double check to see if you have included all of the basic elements in your document.
Start the form by writing “In case of emergency, I give consent to [NAME] …” Also be sure to include any type of medical conditions the individual has such as allergies or illnesses, as well as important phone numbers of doctors or clinics, and your own personal number. As always, remember to sign and date the document.
Medical Records Release Authorization Form
Authorization to Disclose Protected Health Information
Sample Authorization for Release of Medical Information
General Medical Records Release and Authorization Form for Use or Disclosure of protected Health Information
What Makes the Medical Release Form Document Legally Binding?
This is a good question. You can’t just scribble up a note and hand it over to someone, expecting that it will be accepted. Remember, a medical release form is a document that serves to protect as well as release data, and so you want it to be able to stand up in court. There are three basic factors to consider that make the medical release form legally binding.
The Statement of Consent
To be legally binding, the statement of consent must be clearly stated and to the point. All of the parties involved must be named, as well as the organizations involved. There can be no generalizations here, be specific.
Of Age and Sound Mind
In order for this to be legally binding, the author, or ‘releasor’ of the medical release form document has to be a legal adult, and mentally competent. This insures that the individual knows exactly what it is they are signing.
Signature and Date
Like with most important documents, it’s not worth its salt if it is not properly signed and dated. This shows that it is a voluntary act, and not forced, as well as making sure that the individual who is responsible for any care to the dependent, is not held liable for any legal or financial liabilities, so it’s protection for both parties.
Using Our Free Medical Form Templates
As you can see, while it is possible to create your own medical release form, it is actually quite complicated. In fact, a medical release form is not something to be taken lightly, especially due to the legalities involved, so you really don’t want to miss any details. This is why most people choose the direct and hassle free way, which is to use medical form templates. Medical form templates ensure that you will have all of the information you will need for your particular situation, right in front of you, and in a professionally formatted layout.
We are providing you with over 25 medical release templates which are designed to suit various situations which include insurance, dental, school, child consent form, for field trips. Each and every one of our templates are customizable by using Microsoft Word. Simply choose the template that works best for you, download it and proceed to customize it. After which you either save it to disk or print out as many copies as you will need. We guarantee that by using our medical release form templates, your mind will be at rest, knowing that you have completed a comprehensive and exact form, leaving nothing open to chance.
