40+ FREE Medical Record Release Forms (Word | PDF)

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

Basic elements of release form include:

  • 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 a 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, an 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 bylaws 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.