Medical Records Release Form Template

All states | 8 types
Medical Records Release Form Page 1
4.9 (13 reviews)
Updated Jan 19, 2024
~ 2 pages
A medical records release form is a formal document that legitimizes the sharing of a patient's medical information between healthcare providers, insurance companies, or directly with the patient. You will need the medical release form whenever there is a necessity to share a patient's health information. Download this form in PDF from Lawrina and complete it in seconds using the instructions below.
This template is available in one format.
Document Types
Car Accident Release of Liability Form
This form becomes essential whenever there's a settlement following a car accident.
Release of Liability Form
This form protects the parties from potential lawsuits in case of accidents or damage.
Lease Agreement Release Form
A lease release form discontinues the landlord and tenant relationship.
Media (Video) Release Form
This form protects the rights of parties involved in the production and use of video content.
Photo Release Form
This document provides the model’s permission to use their photos in public.
Release of Lien
This form removes any encumbrances on the property, permitting its sale or refinancing.
Talent Release Form
This form is impeccable in the daily work of content creators and talented persons.
Paper titled "Medical Records Release Form"; doctors talking near the desk

In healthcare settings, maintaining accurate records is integral to ensuring consistent and effective patient care. These records contain crucial data and details related to the patient's health and medical history. A medical records release form plays a vital role in these circumstances. It's a formal document that legitimizes the sharing of a patient's medical information between healthcare providers, insurance companies, or directly with the patient.

A key aspect of this procedure is compliance with the Health Insurance Portability and Accountability Act (HIPAA). This federal act sets standards for data privacy and security, specifically protecting medical information. The correlation between a medical release form and HIPAA is of utmost importance, as HIPAA extends the need for such forms to ensure observance of the law and preservation of patient's privacy rights.

When to Use a Medical Records Release Form

You will need a HIPPA medical release form whenever there is a necessity to share a patient's health information. This could occur when a patient is transferring to another healthcare facility or when they're dealing with a medical situation requiring the disclosure of their comprehensive health history. The release of medical records, also known as the transfer of health information, is a legal process confirming the patient's consent for the healthcare provider to disclose their protected health information. 


  • Disclosing party — This is typically the healthcare provider or institution that initially holds and maintains the patient's health records. It is the disclosing party's responsibility to protect this sensitive information and share it appropriately and legally. When a patient provides the necessary consent, the healthcare provider issues a release of medical records form. This document signifies that the provider has the authorization to divulge the patient's protected health information to the specified receiving party.

  • Receiving party — This would be the individual, another healthcare provider, insurance company, or legal institution that is authorized to receive the disclosed medical records. As part of the process, the receiving party ensures the data is received securely and used strictly for the purpose outlined in the release of the medical information form. Upon receipt, they are responsible for the appropriate use and further protection of the shared medical information. 

Key Terms

  • Disclosing party: The healthcare facility, provider, or physician that holds and discloses the patient's medical records.
  • Receiving party: The individual or organization to whom the medical records are released, such as a medical professional, an insurance company, or a legal institution.
  • Protected health information (PHI): Refers to any health information a healthcare provider has about a patient's past, present, or future physical or mental health.
  • Purpose of disclosure: The specific reason for which the patient's records are being disclosed. This needs to be expressly stated in the medical authorization form.
  • Consent: This relates to the patient's voluntary agreement, providing authority to the disclosing party to release their PHI to the receiving party.

How to Write a Medical Records Release Form

Creating a medical information release form requires careful attention to detail as it deals with sensitive personal information. The form should clearly identify the disclosing and receiving parties and specifically highlight the pieces of information to be released. 

Let’s look at the generic medical release form crafting key steps:

  1. Identify the disclosing party:
    Clearly mention the name and contact details of the healthcare provider or institution holding the medical records. This is the entity from whom the records will be released.

  2. Identify the receiving party:
    State the name and contact information of the person, medical institution, or another third party that will be receiving the medical records.

  3. Mention patient details:
    Include the full name, date of birth, and other relevant details of the patient whose records are to be released.

  4. Specify information to be released:
    List the specific types of health information that will be disclosed in the medical authorization release form. It's important to be precise to avoid unnecessarily exposing sensitive details.

  5. State purpose of disclosure:
    Clearly express the reason why the medical information is being shared. It could be for a new healthcare provider, insurance purposes, or legal cases.

  6. Include expiration date:
    The form should state the agreement's expiration date, that is, when the consent for sharing the medical records will no longer be valid.

  7. Ensure patient understanding and consent:
    The patient must fully understand their rights related to their medical data and the implications of sharing it. They should also provide their dated signature as a sign of their voluntary agreement.

  8. Notary public or witness (if necessary):
    In some cases, it might be needed to have the authorization to release medical information notarized or signed by a witness to prove its authenticity and validity.

Managing the transfer of medical data demands accuracy and comes with the fundamental expectation of privacy, trust, and mutual understanding between the involved parties. An authorization to release medical records outlines the parameters and conditions of this interaction. Specifically, it works to protect sensitive medical information, the key asset in these scenarios.

In essence, drafting a detailed and legally compliant document requires significant effort and expertise. Thankfully, it's comforting to know that printable medical release form templates are readily available. These templates act as a helpful tool, allowing healthcare providers to follow appropriate procedures when sharing essential health information.

The increased accessibility of resources, such as a free medical release form, assists in maintaining transparency and mitigating potential legal disagreements. More importantly, medical release form templates enable healthcare providers to uphold a high standard of patient care, emphasizing the significance of these documents in the healthcare sector.