Medical Release form Template Printable in PDF & Word



A Medical Release form Template is an essential document that allows healthcare providers to share medical information about a patient with others who have a legitimate need to know.

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This may include family members, other healthcare providers, or insurance companies. The Medical Release form Template permits to the disclosure of the patient’s protected health information (PHI), as governed by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

A medical release form is a pre-designed form that can be customized for specific purposes. Templates save time and effort and ensure that all required information is included. In this article, we will discuss the importance of medical release forms and guide how to use a template to create one.

There are many reasons why a medical release form may be needed. Here are some common examples:

  • Family members may need access to medical information if the patient is unable to communicate due to illness or injury.
  • A patient may want to share medical information with a specialist or other healthcare provider.
  • Insurance companies may require medical records to process claims.
  • Employers may require a release form before providing disability accommodations.

Without a medical release form, healthcare providers cannot share a patient’s medical information without the patient’s express permission. This can lead to delays in treatment or problems with insurance claims.

Printable Medical Release form Template in PDF and Word

A medical release form is a document used to authorize healthcare providers to share a patient’s medical information with other individuals or organizations. It is crucial for patients who want to ensure that their medical records are shared only with authorized people. Buying a medical release form template from Templatediy not only saves time but also ensures that the form complies with legal requirements.

A medical release form should include the following information:

  • Name, birthdate, and contact information of the patient
  • Name and contact information of the healthcare provider or organization releasing the information
  • Name and contact information of the healthcare provider or organization receiving the information
  • Specific information to be released (e.g., medical records, lab results, diagnosis)
  • Purpose of the release (e.g., treatment, insurance claim, disability accommodation)
  • The date range for the release (e.g., all records from the past year)
  • Signature of the patient or legal guardian, indicating consent for the release of information
  • Date of the signature
  • A statement indicating that the patient has the right to revoke the release at any time


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