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.
We offer the free HIPPA Medical Records Release Form in PDF format only. We were unable to convert the form to Microsoft Word due to unusual formatting on the PDF. The PDF will open in a new window so you can print or save it.
Click the link below to download the HIPPA Medical Records Release Form in Microsoft Word format for free. You may also create the HIPPA Medical Records Release online for free using our free EZ Online Forms. The EZ Online Forms take all the uncertainty out of which information goes on what line. Answer the simple questions and your answers will be electronically filled into the completed form.
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.
PDF (fill-in-the-blanks) – HIPPA Medical Records Release Form
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