Generic Medical Record Release Forms of 33 States

If you have never requested a medical record release, you might not be having a deeper understanding of what we are talking about. This is a written permission to authorize the disclosure or the use of personal protected medical records. This includes your medical history and the records that are maintained by the healthcare providers.

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The health providers are actually mandated by the law not to release an individual’s medical records unless directed otherwise.

A medical record release has some basic elements including:

  • Who will disclose and who will receive the information,
  • The information released,
  • Where the information will be disclosed,
  • Why the disclosure,
  • When the authorization expires and
  • How the authorization can be revoked

The process can seem to be complicated when it is your first time but it is actually quite simple. The same procedure is used across different states. State laws will only add few variations to the exact process as you request for the records and the facility fee.

Any medical information is highly sensitive and confidential. It is protected in the best ways they can as they try to avoid any case falling into the wrong hands. There are facilities are required to verify the identity of the requester and confirm that you are authorized to access the required transfer records.

Medical Record Release Forms by States

Alabama

Alabama Medical Records Release Form

Alabama Patient Authorization Disclosure Sample

    Alaska

     Releasing of Medical Information Format

      Arizona

      Free Download Medical Records Release Form

      Printable Arizona Medical Records Release Form

      Release Protected Health Information Sample

        Arkansas

        Arkansas Authorization to Obtain Medical Information Form

          California

          Authorization For Use Or Disclosure of Health Information Sample

          Release of Health Information Form

          Disclosure of Patient Health Information

          California Release of Medical Information

            Colorado

            Colorado Medical Permission For Release Form Sample

            Colorado Medical Release Form Free Download

            Colorado Medical Release Form Sample

              Connecticut

              Connecticut Authorization For Medical Release of Information

              Sample of Connecticut Medical Release of Information

                Delaware

                Authorization for Protected Health Information Form

                Delaware Authorization for Disclosure of Protected Health Information

                  Florida

                  Florida Medical Records Release Form PDF

                  Free Download Florida Medical Records Release Form

                  Authorization To Disclose Health Information Sample

                  Printable Medical Records Release Form

                    Georgia

                    Printable Georgia Medical Release Form Sample

                     Georgia Medical Release Form Format

                    Printable Georgia Medical Release Form Sample

                      Hawaii

                      Authorization to Disclose Protected Health Information Form

                        Illinois

                        Sample of Authorization To Release Medical Records

                        Authorization For Release of Confidential Health Information Sample

                        HIPAA Authorization To Use And Disclose Health Information Form

                        Release of Medical Information Form of Illinois  Authorization To Release Medical Records Form Sample

                          Indiana

                          Indiana Medical Records Release Form PDF

                          Printable Indiana Medical Records Release Form

                          Free Download Indiana Medical Records Release Form

                            Kentucky

                            Release of Medical Information Form of Kentucky

                              Louisiana

                              Release of Protected Health Information Sample

                              Louisiana Release Or Obtain Health Information Format

                                Maine

                                Authorization to Release Medical Information and Records Form

                                  Maryland

                                  Maryland Medical Records Release Form Format

                                  Free Edit Medical Records Release Form

                                    Michigan

                                    Editable Michigan Medical Records Release

                                    Michigan Medical Records Release Sample

                                      Minnesota

                                      Minnesota Release Protected Health Information Sample

                                        Mississippi

                                        Mississippi Authorization to Release Medical Information

                                          Missouri

                                          Printable Missouri Medical Record Release Form

                                          Missouri Medical Record Release Form Format

                                          Missouri Medical Record Release Authorization

                                            New Jersey

                                            Free Download New Jersey Medical Records Release Form

                                            Editable New Jersey Medical Records Release Form

                                            New Jersey Medical Records Release Sample

                                              New York

                                              New York Medical Records Release Form Format

                                              Free Download New York Medical Records Release Form

                                                North Carolina

                                                North Carolina Medical Records Release Form PDF

                                                North Carolina Medical Records Release Form Sample

                                                North Carolina Medical Records Release Form Format

                                                  Ohio

                                                  Ohio Authorization For Release of Medical Information Sample

                                                  Ohio Medical Records Release Form PDF

                                                  Ohio Medical Records Release Form Format

                                                  Ohio Medical Records Release Form Free Download

                                                    Pennsylvania

                                                    Pennsylvania Medical Records Release Form Sample

                                                      South Carolina

                                                      South Carolina Medical Record Release Forms

                                                        Tennessee

                                                        Tennessee Medical Records Release Form Format

                                                        Tennessee Medical Records Release Form Sample

                                                          Texas

                                                          Free Download Texas Medical Records Release Form

                                                          Sample of Texas Medical Records Release Form

                                                          Texas Medical Records Release Form

                                                            Virginia

                                                            Virginia Medical Records Release Form Free Download

                                                            Printable Virginia Medical Records Release Form

                                                            Virginia Medical Records Release Form

                                                              Washington

                                                              Sample of Washington Medical Records Release Form

                                                              Washington Medical Records Release Form PDF

                                                              Washington Medical Records Release Form Free

                                                                Wisconsin

                                                                Wisconsin Medical Records Release Form Free Download

                                                                Wisconsin Medical Records Release Form Format

                                                                Wisconsin Medical Release Form 01

                                                                  Steps to Complete a Patient Access Request

                                                                  This is in other words known as the authorization form. To access the records, you will first visit the health information management department. After contacting them, this is the first step that you will begin with.

                                                                  There are many health facilities offering this service online but to many others, you need to be physically present in the office. There are others that will require that you fill the forms through email for the record services that you are requesting.

                                                                  To access any record you must be having a complete and signed authorization form. It will as well depend on the provider’s policies to access the required information that they need to have.

                                                                  Select your Records

                                                                  In the access request form, you will be required to provide the different specific information that you want to be copied. At times it is difficult to know the exact forms that you need. In this case, a HIM professional will be right there assist you. They can narrow down your requests and help you in getting to understand what you require.

                                                                  A patient is often allowed to ask for the records in the format that pleases them. You can request the form in a CD, DVD, USB, in a flash drive or any other way.it can even be sent to your email.

                                                                  Photo ID

                                                                  When you are physically asking for your records, a government-issued photo ID will be required. It is mainly required when you are picking the records. This is to confirm that you are who you say you are. They HM assistant will cross check your photo and you face and crosscheck against your name in the ID and in the records. Any failure to match you cannot access the documents.

                                                                  Time Consumed

                                                                  Access to your medical records doesn’t happen in a flash. You, therefore, need to plan ahead of time to avoid being caught off guard. There are those that give a span of up to 30 days. This also has an allowance of 30-days to get the files in place. Most of the facilities will, however, take 5 to ten days. It is the state by laws that dictate how fast you can access your requests.

                                                                  The process is not free. There are fees that might be charged by different facilities to offset the labor involved in getting your requirements in order. There are however some facilities who provide free services on the records though they must be within the law requirements.