Get the free Medical Record Release / Request Authorization

This document serves as a medical record release and request authorization form for Curry College Health Services. It allows patients to authorize the release or request of their medical information and designate individuals who can discuss their health care details. The form ensures compliance with the Family Education Rights and Privacy Act and Massachusetts General Laws.

How to fill out medical record release request

How to fill out medical record release request

1. Obtain a medical record release request form from your healthcare provider's office or website.
2. Fill out your personal information, including your name, address, date of birth, and contact information.
3. Specify the medical records you wish to be released, including dates of treatment or specific documents needed.
4. Indicate to whom the records should be sent or if you wish to pick them up in person.
5. Sign and date the form to authorize the release of your medical records.
6. Submit the completed form to the appropriate healthcare provider or institution.

Who needs medical record release request?

1. Patients who want to transfer their medical records to a new healthcare provider.
2. Individuals seeking to obtain their own medical records for personal use or review.
3. Healthcare providers needing access to a patient’s previous medical history for continuity of care.
4. Family members or legal representatives who require access to a patient's medical records with proper authorization.

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What is medical record release request?

A medical record release request is a formal document that allows patients or authorized individuals to request access to a patient's medical records from healthcare providers.

Who is required to file medical record release request?

Any patient or authorized representative, such as a family member or legal guardian, is required to file a medical record release request to obtain access to medical records.

How to fill out medical record release request?

To fill out a medical record release request, you need to provide your personal information, details about the records being requested, the purpose of the request, and your signature.

What is the purpose of medical record release request?

The purpose of a medical record release request is to obtain permission to access, share, or transfer a patient's medical records for continuity of care, legal reasons, or personal review.

What information must be reported on medical record release request?

Information that must be reported includes the patient's name, date of birth, specific records requested, the purpose for the request, and contact information of the person requesting the records.