8+ Sample Medical Records Release Form Template

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What Is Medical Records Release Form?

A medical release form is a document of the patient’s history which is saved by the hospital. This document is usually asked by the legal representative or patients’ to be sent to other facilities or to inspect the copy. The document has date and sign and each hospital has different regulation. Therefore, sometimes asking a medical records release form will take a few days. But sometimes we just want to know about the content in the document and what kind of thing that will be explained inside. Therefore, the sample medical records release form in this page is uploaded for free for you. You can learn it from our samples and even this is also editable.

What Is HIPAA and What Is It For?

The HIPAA stands for the Health Insurance Portability and Accountability Act. This document will allow someone to list the names of the family, relatives, health care providers, friends, clergy and other third parties to get access to the information. Therefore, if someone is asking a medical record of someone and their names are not listed in the HIPAA, they cannot obtain it because this information is considered to be private.

Will We Have To Some Fee When Requesting A Medical Record?

For some cases, requesting a medical record will not be charged by the hospital, but the hospital will notify everyone in advanced when a fee is applied. Furthermore, asking a medical record for the representative will not be allowed if they don’t have the written authorization from the patients except it is permitted by the law.

How To Request A Medical Record?

Accessing a medical record is under your local law, so make sure you follow it. Besides, it can take several days to be completed. Usually, it takes within 30 days. Here are some steps on how to request the medical records.

Requesting Medical Form Through A Form

There are four sections you should write which are releasor and recipients, record types, time period and also the expiration date. You can use the standard form on our page. It is available for free. But if your hospital wants you to use their format, use it and write it neatly.

Sending The Letter

It is better to notify the hospital what kind of document you need. It can be in written, audio, or video documents. You can request it in the form of CD, Flash Drive and also PDF/Word.

Receiving The Medical Records

Receiving a medical record can be quiet long. If you don’t get the medical record within 7 business days, then the requestor or your legal representative should call the hospital to know the status of its transfer. The maximum day you should wait for receiving the medical record can be 30 days. But if they cannot meet this date, they will send a letter to the requestor telling why the request is delayed. Usually, it only takes one extension period allowed.

If you are requesting a medical record by someone else, you need to follow certain regulation based on your local law and it is asked by your representative, the guardians and another third party that is allowed. So, make sure you are listed here and guaranteed by the law.

Attachments

File	File size	Downloads
Sample Medical Records Release Form Template	491 KB	90