A medical release is a written consent that may authorize a doctor to look at your medical record or child medical release authorizing emergency medical care or treatment in the event a child or relative gets sick while you’re away from home. A medical release form therefore has two purposes: to check your medical history so you can get medical treatment, or to authorize treatment to a child or relative if any one of them gets sick.
Our Sample Forms for medical release can be downloaded and printed for immediate use by filling up the necessary spaces, or can be used as reference in case users want to make their own medical release forms.
HIPAA Medical Release Form
Sample Medical Release Form
Simple Medical Release Form
Printable Medical Release Form
Free Medical Release Form
In the case of your medical history, it’s very important that you are diagnosed correctly when seeking treatment. It’s equally important that you use medicines that will not react negatively on your body and may have the potential to worsen your condition, which could prove fatal. Doctors, however, cannot just access your medical history freely without your consent. It’s for this reason that a medical release form needs to be used to access your medical record.
You can do this by filling up one of the samples offered here giving permission to your doctor or the hospital to access your medical history that may be located in another hospital or medical facility. You would need to supply the necessary information on the form like your date of birth, maiden name (for married females) and social security number. You should also write the name of your doctor or the hospital you authorize to access your medical history under the line that says, “I authorize the release of my medical history to…”
In writing a medical release form, you may opt to write a short, detailed summary of your medical history and/or if you’ve had any past operations in any part of your body plus the medicines you have been taking. This will give the doctor or hospital a general idea of your specific medical condition and will come helpful in case your condition suddenly worsens and you become unresponsive while waiting for your doctor to receive your medical history.
Sample Medical Records Release Form
Medical Information Release Form in PDF
Parent Medical Release Form
Youth Medical Release Form in PDF
When authorizing a medical release, you should know that it is within your legal right to withhold information you don’t want to reveal in your medical condition like sexually transmitted diseases and HIV or AIDS. Treatment for alcoholism and drug abuse may also be withheld unless you state otherwise. Withholding these kinds of information may or may not help your condition, but it’s perfectly acceptable and understandable if you want to keep any of those kinds of information private and confidential.
For users who may want to authorize use of their photographs for whatever reasons these are intended for, please click on the links for our samples of Media Release Forms and Video Release Forms. These are intended for all types of media devices that would capture your image, name, or any of your other identifying features that would need your written consent.
8+ Sample Pledge Forms – PDF, Word
7+ Print Release Forms – PDF
10+ Patient Feedback Forms – PDF, Word
6+ Sample Construction Work Order Forms – PDF
8+ Sample Registration Forms – PDF, Word
8+ Registration Form Samples, Examples, Templates
8+ Rental Application Form Samples, Examples, Templates
8+ Sample Rental Application Forms – PDF, Word
10+ Sample Donation Request Forms – PDF, Word
10+ Donation Request Form Samples, Examples, Templates
9+ Sample Employee Uniform Forms – Word, PDF
8+ Sample Submittal Transmittal Forms – PDF, Word
10+ Sample Liability Waiver Forms – Word, PDF
7+ Employment Application Form Samples, Examples, Templates
8+ Sample Employment Application Forms – PDF, DOC