Medical Records Release Form

Patient Release Form
Download a medical release form.

According to the Federal HIPAA Privacy Rule, your medical records are considered private and confidential. No one can see them without your express permission. This helps protect you from unlawful discrimination due to your health status. The medical release form provides that permission, when needed.

When a Medical Records Release Is Necessary

A release form signed by you is necessary whenever an individual or organization seeks:

  • Copies of anything medical providers inserted into your medical record
  • Information about you that's stored in the computer system of your health insurance company
  • Financial information about you - such as bills - that your medical office has stored in its computer system

At times, you need this information to be shared, such as if you are incapacitated due to injury or illness and need to appoint someone else as your caregiver, if you need to share lab results with a physician, if you are changing care providers or if you are receiving treatment from more than one care provider for the same condition. Medical records may also be required for insurance purposes, legal reasons, employment in some jobs or enrollment in certain education programs.

Completing the Attached Form

If you are provided with a release form by the party requesting it, it's advised to use that form. If not, you may be able to use the attached form for a general release of your information. If you need help downloading the form, check out these helpful tips.

Using the form is simple:

  • Click on the form's image at the top of this page.
  • After the document opens in PDF format, click anywhere in the form to add text or make edits.
  • Click on the disk icon to save your completed form.
  • Print it out or click the envelope icon to send your form by email.

Use Discretion in Releasing Information

Regardless of which form you choose to use - whether it's one provided by the organization that needs access to your records, or a form that you obtain yourself - it's important that you carefully consider when it's appropriate to release your medical records.

There are times when you may want to think twice about signing a release. For example, if an ex-spouse's lawyer is asking for access related to divorce proceedings or if an employer's insurance company is asking for access related to your personal injury court case, you may want to consider talking to a lawyer before agreeing to release your medical records. The Federal Government created the HIPAA privacy rule for good reason, so allow the law to work in your favor and release your medical information sparingly.

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Medical Records Release Form