Looking for a medical record release form
 

Anyone know where I can find a standard medical record release form online? I have looked online but can only find ones for other people, I can't find just a blank one with-out some other medical offices name on it.

TIA :)

Call your doctor's office and ask them to fax you one.

Well I was wanting one for my old Dr, the hospital that did the C spine MRI and the clinic that did the brain MRI and the lab that did all my lab work so I was hoping to find a blank one and just send that to everyone.

I've never used a specific form, just a faxed note that I give permission for my records to be release to X. That's all I've ever needed.

Oh, OK thanks. I guess I though it had to be "All Legally worded" or something.

Records Release form {example}


Patient’s name _____________________________________________

Date of birth ____/____/____
Social Security Number ______-___-_______
Address
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Telephone number (____) ____-_______

Please release my medical records from:
Name of provider
__________________________________________
Provider’s address
__________________________________________
__________________________________________
__________________________________________
__________________________________________


TO:
[NAME AND ADDRESS HERE]




Please release all records, including but not limited to, progress notes, operative notes, laboratory
test results, diagnostic tests, and x-rays.

I HEREBY AUTHORIZE THE RELEASE OF MY MEDICAL RECORDS AS PROVIDED ABOVE.

Date: ______________________________

Patient’s Signature:________________________________________

Oh wow, Thank you so much. :D

You may want to contact the medical facilities as some usually require their specific medical release form. Try looking them up on-line and see if they have a forms section.

Also, your physician should have all of those reports so you may want to save money and see what he/she has before paying for all of those.

Oops just saw that you are in TX. Check w/the TX State Board of Medical Examiners as they regulate doctors and have all the rules listed on their site. They may have a release form there, can't remember. They also let you know what the facilities are allowed to charge you--more knowledge the better w/some of the offices there(just my personal experience anyway).

I have looked online, I did ask my Dr for all the reports, he doesn't have the MRI films (doesn't even care to see them him self). Thank you.