HIPPA Medical Records Release Form

The HIPPA Medical Records Release Form is used to receive a copy of your medical record(s) or to have them sent to another party. The form is commonly used when switching doctors or health care providers. Under the strict guidelines of the HIPPA law, health care providers can’t share your medical information with any third party including your parents, children, or even your spouse.

The HIPPA Medical Records Release Form requests that a health care provider share specific health information with another person or group. You might want your medical records sent to another doctor, hospital, or health care provider. The health information could be records from your medical file, rehab treatment, psychiatric visits, or anything similar.  

Some states provide their own HIPPA medical records release form but you are not required to use the state form. The form below is HIPPA-compliant.

Click the link below to download the HIPPA Medical Release Form. The document is in PDF format. You can print the form and bill in the blanks. If you wish to type your information into the form, it can be converted into a fillable form using any PDF document editing software.

DOWNLOAD – HIPPA Medical Records Release Form PDF


We must include the following legal disclaimer:

The HIPPA Release of Medical Records Form and other legal forms available on this website are provided “as is” without any express or implied warranties of any kind including, but not limited to, warranty of merchantability or fitness for any particular purpose. It is your responsibility to determine if the form can be used in your state.

As a user of this website, you assume all responsibility and risk for the use of the HIPPA Release of Medical Records Form or any legal form obtained from the site. We do not assume any legal responsibility or liability for the accuracy or usefulness of the legal forms generated by the templates we offer. We will not be liable for damages or compensation, whether direct, indirect, or incidental, resulting from the loss of use or profit arising out of or in connection with the use or execution of the legal forms or the form templates.


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