FREE 8+ Sample Medical Authorization Release Forms in MS Word | PDF

Under the Health Insurance Portability and Accountability Act regulation of the United States, an individual’s identity and privacy is protected at all times. For this reason, medical health records are kept with utmost confidentiality and can only be released with the patient’s approval.

Our Sample Forms for medical authorization release have all the necessary information needed by users who may want to be guided on how to draft their own medical release forms for their own use. These are all free to download and modify according to their own specifications.

HIPAA Medical Authorization Release Form

Medical Records Authorization Release Form

Sample Medical Authorization Release Form

Medical Treatment Authorization Release Form

Generic Medical Authorization Release Form in PDF

A medical authorization release form acts as a consent that will authorize your physician to refer to your medical record for proper treatment. He may diagnose you based on your medical history to prevent any complications that may arise if you’re allergic to certain drugs. A medical authorization also has two purposes: to check your medical history so you can get proper medical treatment, or to authorize treatment to a child or relative if any one of them gets sick.

Regarding a patient’s medical history, it’s very important that there is a correct diagnosis when seeking treatment. It’s equally important that medicines being administered will not react negatively on the patient’s system, which may have the potential to worsen the condition that could prove fatal. Doctors, however, cannot just access a patient’s medical history freely without his or her consent. It’s for this reason that a medical authorization release form needs to be used to access the medical record.

For users who may want to use any of our forms can do this by filling out one of the samples offered here giving permission to your doctor or the hospital to access your medical history. Since your medical record may be located in another hospital or medical facility, you may need to supply the necessary information on the form like your date of birth, maiden name (for married females) and Social Security number. You may also write the name of your doctor or the hospital you authorize to access your medical history under the line that states, ” I authorize the release of my medical history to….” You may also want to modify the form to your own liking.

For other examples of different forms that you may find relevant, do check out more on our website or click on the links for Records Release Forms and Credit Release Forms that are all free for downloading.

Medical Treatment Authorization Release Form for Minor

Mutual Medical Authorization Release Form

Patient Medical Authorization Release Form

Medical Authorization Information Release Form

On the medical authorization release form, you may choose to write a short but detailed summary of your medical history, especially if you’ve had any past operations in any part of your body, including the medicines you have been taking. This will give the doctor or hospital a general idea of your specific medical condition and will be very useful in the event your condition may suddenly worsen and you become unresponsive while waiting for your doctor to receive your medical history.

For users who need to write a consent letter for the treatment of their children while they’re away, we also have Child Medical Consent Forms that can be downloaded and edited or modified. These can also be printed and used immediately after downloading. These are all available in both Word Doc and PDF files.