Free Medical Records Release Authorization Forms (HIPAA)

Free Medical Records Release Authorization Forms

The release of medical records is the disclosure of the members of the family or next of kin whom a person would wish to have access to his medical records. Medical records are very confidential pieces of documents that are kept off the public limelight ordinarily. In 1996, a federal law was specifically passed to safeguard these records from arbitrary public access. This was the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It, alongside a host of state laws, bind healthcare providers from disclosing medical records arbitrarily without the patient signing any forms to authorize the same.

It also stipulates some rights for the patients concerned to understand how the information regarding their health shall most likely be used later. Its major goal is the proper protection of the health records of individuals and other third parties.

You can find more information about the law at following link:

As per the act, only those who have been expressly mentioned can access the medical records contained in the authorization form. They have to reveal themselves first and foremost before being granted access to medical records. Closely related to this is the extent to which they might access the prevailing records. The patient has the prerogative to limit each named person to specific portions of the information. For instance, a parent might gain more information compared to distant kin.

Basic requirements of HIPAA

In order for the form to be deemed valid as per the HIPAA standards, it has to contain some bare minimum set of information. These following are the core pieces of information it has to provide:

  • Patient’s full name
  • Date of birth of the patient
  • Medical record number assigned to him by the healthcare facility
  • Address – Both postal and physical address. These addresses are for the residences rather than the workplaces of the patients
  • Phone number of the patient
  • List of all those who are authorized to access the medical records of the patients concerned

Note: As per the HIPAA rules, this form shall be deemed incomplete not unless it contains all the information stipulated above. This might call for any amendments until the bare minimum threshold is finally attained.

When are these records needed?


The records may be ordered for access by a court of law. They may be used for furnishing evidence of the health status of the accused or as a supporting document on any argument within a court of law. Also, the records may serve as an alibi in the case of mistaken identity.

Settlement of Heath Fees

If seeking support from an insurance provider to the settlement of health fees, the records may yet again come in to aid in determining how much to pay and how to pay them. That is because they provide a breakdown of the costs involved in mitigating specific health conditions and how much they accrue collectively.


Employers may also require the forms if they want proof that their employers were indeed out of work deservingly. If the employer runs a health scheme for the employees, it may rely on these forms to prove that the employee was indeed hospitalized. This also determines how much to pay and whom to pay.

Basic contents of medical release form

To be deemed valid, a simple medical release form must contain the following fields:

  • Authorized Request – The names and identities of the persons who are authorized to seek access to the health records.
  • Recipient – Identities of the other persons who may have a right to access the information.
  • Specific Information – A description of the specific piece of information to be disclosed to or used by a person.
  • Risk of Disclosure – The potential harm, damage, or danger that the disclosure is more likely to inflict.
  • Expiration – An ultimatum or deadline within which the authorization may be effective.
  • Revocation – A written statement by the patient himself authorizing the surrender of his rights.
  • Purpose – Descriptions of the exact purposes of the disclosure itself.
  • Date and Signature – Date when the authorization was made and the signature vouching for such an authorization.

Release Forms (by State)

Release Form Templates

Authorization Generic Medical Records Form

HIPPA General Release of Information Form Free

Authorization to Disclose Health Form

HIPAA Authorization to Release Medical Information Form

HIPAA Authorization Form for Patient

HIPAA Authorization for Use or Disclosure of Health Information

Other names of this form

This form goes by several other names. Below are but a few of them:

  • Medical Record Release Form
  • Medical Release Form
  • HIPAA form
  • Medical Authorization Form

Related Posts