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Get the free MEDICAL RECORDS RELEASE From GAT 1-27-15.doc

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Alan J. Gamsey, MD, FACP, FACG, AGAF Felix P. Tiongco, MD, FACP Walid F. Makdisi, MD Brian M. Sullivan, MD Shoba Mendu, MDRene J. Rivera, MD Jeremy P. Domanski, MD Katelyne Hale, PAC Amber Stewart,
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01
Obtain the medical records release form from the healthcare provider or facility.
02
Fill in your personal information such as name, date of birth, and contact information.
03
Specify the healthcare provider or facility you want to release your medical records to.
04
Include the dates of the medical records you want to release.
05
Sign and date the form to authorize the release of your medical records.
06
Keep a copy of the completed form for your records.

Who needs medical records release from?

01
Patients who want to transfer their medical records to a new healthcare provider.
02
Legal representatives who need access to a patient's medical records.
03
Insurance companies requesting medical records for claim processing.
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A medical records release form is a document that allows a patient to authorize the disclosure of their medical information to authorized individuals or entities.
Patients or their legal representatives are typically required to file a medical records release form to permit access to their medical records.
To fill out a medical records release form, a patient must provide their personal information, specify what records are requested, indicate who the information is being released to, and sign the form.
The purpose of a medical records release form is to ensure that a patient's medical history is shared legally and transparently with healthcare providers, insurers, or other authorized parties.
On a medical records release form, the patient's full name, date of birth, contact information, the specific records being requested, the name of the recipient, and the patient's signature are typically required.
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