From medical consent form, DRN, doctor’s note, child consent, generic medical release form, discharge summary, medical release from to medical authorization form, the list goes on and on, when it comes to extra care in legal matters. The information that is sensitive enough to share requires an authorize and an authentic form signed by both parties.

When a patient wants to know his medical history and not just him but he wants to involve someone else in that as well then in that case a form is required which is known as medical release form Where medical information is released by the doctor to the patient and to others.

When is it required?

There are many different cases when a medical form is required and most noticeable are:

  • When a child is left to a caretaker, parents decide to give the authority to a caretaker to release the medical information at the time of the need.
  • when a patient needs to travel somewhere then generally a medical history is required to be drawn by the doctor of the patient so that in case if he is not well during the journey the other doctor should quickly draw the issues.
  • When any relative of the patient wants to know his medical history the form is used.

What this form contains?

The form has basic general requirements to be filled before the withdrawal of the info. There are five w’s to be answered

  • Who wants the information?
  • who will give the information?
  • how the name of both parties is present in the form?
  • Why the medical information is required and why is the certain person wants the information to be disclosed
  • What medical information will be disclosed and of course how much information is going to be shared

There is a limited time for which the authority is being given to any person so the form also mentions the expiry date of the authorization.

After answering all what, who, when, where and why both the parties sign the form and give some personal information such as name, contact number, email ID and address.

Healthcare Information Release Form

Healthcare information release form


Medical Record Release Request Letter

Medical record release request letter


Medical Record Release Authorization Letter to Doctor

Medical record release authorization letter to doctor


Letter Requesting not to Release Health Record

Letter requesting not to release health record


Letter Authorizing to Release Medical Records

Letter authorizing to release medical records


Letter Requesting Copies of Medical Record

Letter requesting copies of medical record


Authorization to Release of Medical Record Information

Authorization for release of medical record information


Example from Other Sources

Authorization to Release Medical Information

Authorization to release healthcare information

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