What You Should Know About a Medical Records Release Authorization Form
Facts About Medical Permission Forms (with Free Printable Medical Release Form)
Most of the information in a medical record is considered Protected Health Information (PHI) by HIPAA. This, as well as other data privacy requirements in various countries, require a medical information consent form before healthcare providers are allowed to share medical records information with others.
What should be included in a printable medical records release form? In what circumstances would a medical consent form for adults or children be used?
In this medical records transfer form guide, we’ll cover the basics of a patient release form. We’ve also included a free medical release form for patient records that you can download or use directly in our All-in-One Client & Case Management Software.
Printable Medical Release Form
When people are treated by a medical practitioner (physician, therapist, dentist, medical specialist, etc.) a medical record is kept, and this person’s medical records become a vital part of providing care and informing future health needs.
There is a lot of sensitive information in a person’s medical records, which is why it can’t typically be shared without some type of form giving permission for the release of medical information.
This guide provides you with what you need to know about the key facts around the release of medical records and includes details on the best medical information consent form.
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Table of Contents: Medical Records Release Form Template
Keep on scrolling down this page to read each section or click any link below to go directly to that section.
- What Is a Patient Authorization to Release Information?
- Who Uses an Authorization to Release Information Form?
- Key Items to Include on an Authorization of Release Form
- What Info Can Be Covered by a Medical Authorization to Release Information Form?
- Free Medical Consent Form | Medical Records Release Form PDF & Word
- Conclusion | Guide to Forms for Release of Medical Records
- FAQ | Release of Health Information Form
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What Is a Patient Authorization to Release Information?
An authorization for release of medical information form is a signed document that gives a healthcare provider permission to release a patient’s medical records. This consent is required by law in many countries to protect the patient’s sensitive data.
Data privacy requirements like the Health Insurance Portability and Accountability Act (HIPAA), Personal Information Protection and Electronic Documents Act (PIPEDA), and NHS Records Management Code of Practice all have strict guidelines for sharing patient records with third parties.
Our All-in-One Client and Case Management Platform complies with all of the above-mentioned laws and comes with a ready-made medical records release form.
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A generic medical records release form will typically include details, such as:
- Patient’s name
- Reason for the request
- Name of the healthcare provider requested to share the medical information
- Name of the entity authorized to receive the medical information
- The type of information to be released
- Disclosures, such as the patient’s rights to revoke authorization
- Signature of the patient or patient’s legal representative
Depending on the healthcare regulations governing the consent form for medical records, there may be other form fields required.
All authorization to release medical records form sample templates will have the same general purpose. However, they may contain slightly different fields and text specific to a particular organization.
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Do you have any questions or feedback about this article on the authorization to release medical records to third-party entities? If so, click here to contact the Social Work Portal Team.
Who Uses an Authorization to Release Information Form?
A consent to release medical information form will typically be requested when someone wants a copy of their own medical records or would like to have them sent to a third party. The request is made to the healthcare provider, therapist, or organization that has the patient’s records.
A form for authorization to disclose protected health information can be used by:
- Doctors’ offices
- Hospitals
- Social workers
- Therapists
- Psychiatric practitioners
- Dentist offices
- Health insurance companies
- Substance abuse centers
- Military/VA facilities
- And others that keep patient records for mental and/or physical health
In most cases, the medical release form for adults, adolescents, or children is mandatory before an organization can release any type of sensitive, protected patient information.
With full compliance with relevant laws and regulations, including the inclusion of a ready-made medical records release form, sign up for SWP’s Case Management Hub software and explore the solution you’ve been waiting for.
Something you need to note is that the form does not give the provider the freedom to release health information to anyone. It restricts that sharing to the entity or entities listed in the authorization for release of protected health information form.
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Key Items to Include on an Authorization of Release Form
The data privacy regulations governing your country or location will provide exact details on the information you are required to have on your consent for release of information template. Below, we highlight some of the typical information that is key to include on a generic medical release form for patient records.
Patient Name: The patient’s name is required, and often a medical record number will also be included.
Name of Organization Holding the Records: In some cases, the name of the entity that has the records will already be included on its authorization to release information template. In other cases, it may need to be filled in.
Name of Entity to Receive Medical Records: This could be the name of the patient if they are requesting a copy of their own records. It may also be another healthcare provider, an insurance company, or some other third party. The address is also typically provided, in addition to the name.
Applicable Date(s): If the records from a specific time period are the only ones to be shared, this should be noted.
Reason for the Disclosure: An authorization for disclosure of health information form might have a multiple choice for the reason, such as “personal use, legal, insurance, treatment, disability, or something else.”
Type of Information to Be Disclosed: Patients may wish to have the full record shared, or only specific information. Many generic printable medical records release authorization forms will specify things like HIV tests, mental health records, drug and alcohol treatment, diagnostic images, deductible and copay details, and more.
Disclosures: Disclosures are usually dictated by company policy or data privacy regulations. An example would be a disclosure of the patient’s right to revoke the authorization.
Expiration of Authorization: In some cases, the patient may wish to include an expiration date, after which the authorization for disclosure of health information is null and void.
Authorized Signature: There should be an area for the patient or their legal representative to sign the authorization for disclosure of health information form. It must be signed by an authorized party to be considered valid.
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Do you have any questions about specific patient release forms, such as the Kaiser release of information form or VA medical records release form? If so, click here to the Social Work Portal Team.
What Info Can Be Covered by a Medical Authorization to Release Information Form?
A person’s medical record can include many different types of documents and communications. Some of these will be listed next to checkboxes for the requestor to select on a medical authorization of release form. However, several may also be grouped under a general category of “all other medical information.”
Here are some types of medical record data that can be transferred to a patient or designated third party via an authorization to release information request:
- Notes
- Charts
- Treatment records
- Medications/prescriptions
- Lab results
- Test results analysis
- Assessment results and analysis
- Diagnostic images
- Digital recordings
- Emails & text messages
- HIV test results
- Drug and alcohol abuse treatment details
- Billing & payment details
- And more
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What information is NOT covered by an authorization to release medical records?
According to HIPAA guidelines, there are two types of information that are not covered by a right to access, and thus would not be included if the patient were requesting a copy of their medical records.
These include:
- Psychotherapy notes
- Information compiled with a reasonable expectation of use in a civil, criminal, or administrative proceeding
Another type of exclusion could be documentation that may use the PHI of an individual but be for a more general purpose of evaluating staff or an organization. Such as a staff evaluation or quality control records.
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Are there more exclusions from a medical permission form that you’d like to share? Click here to contact the Social Work Portal Team.
Free Medical Consent Form | Medical Records Release Form PDF & Word
Below we have a generic printable medical records release authorization form that you can download and edit for your needs. Please note that this printable blank medical records release form does not constitute legal advice. This printable blank medical records release form is for educational purposes.
You should review the data privacy regulations that govern your organization or practice to ensure that any printable medical records release form includes all required form fields, disclosures, and other details.
Just click below to download our free medical records request form PDF or Word document.
Click here to Access and Download Medical Release Form PDF & Word Documents
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Conclusion | Guide to Forms for Release of Medical Records
Any medical practitioner, social worker, mental health provider, or another professional that works with protected health information should be aware of what a medical authorization to release information is and how to use it.
A medical records release form template doesn’t have to be extensive. Many are just one to three pages at most. However, any web-based or printable medical release form should include the basics of what is being shared and who it is being shared with. As well as any disclosures required by data privacy guidelines.
If that’s what you’re looking for, our Client and Case Management Portal is an ideal solution for you.
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As a patient, you have a right to a copy of your medical information and to have your medical records shared with a third party. In most cases, you will be required to fill out a medical records release authorization form before that can happen.
Don’t Miss: See the medical release form pdf downloadable templates above
Do you have any feedback about this authorization for release of protected health information guide? Contact us, we’ll love to hear from you: Click here to contact the Social Work Portal Team.
FAQ | Release of Health Information Form
Requesting a release of medical records is a straightforward process. First, you would contact the healthcare provider that holds your records. Then, you should receive a medical release authorization form from that provider and will fill the form out and submit it. Once processed, either you or the third party that you designated should receive the medical record details that you indicated should be released.
The consent to release medical information would be given by the patient for their own medical records. Or in the case of a minor, it may be given by the parents or guardian of the patient. In the case of a medical consent form for adults regarding an adult that does not have the capacity to sign for themselves, it would be given by a legal representative.
An authorization for release of medical information form is a signed document that gives a healthcare provider permission to release a patient’s medical records. This consent is required by law in many countries to protect the patient’s sensitive data.
A generic medical records release form will typically include details, such as: Image sources: Stock.adobe.comWhat is the process to do a release of medical records?
Who gives the consent to release medical information?
What is a medical release authorization form?
What is included in a patient authorization to release information?
•Patient’s name
•Reason for the request
•Name of the healthcare provider requested to share the medical information
•Name of the entity authorized to receive the medical information
•The type of information to be released
•Disclosures, such as the patient’s rights to revoke authorization
•Signature of the patient or patient’s legal representative
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