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Release of Patient Medical Information

List price: $31.50
You save: $11.25 (36%)
Price in points: 21 points
Reward points: 2 points

This product is electronically distributed.

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A medical release form is a document that gives healthcare professionals permission to share patient medical information with other parties. Patient's must first sign a release.

According to the U.S. Department of Health and Human Services, “An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.” 

Did You Know? Verbal medical release agreements are not sufficient because they are impossible to verify if there’s ever a disagreement. Healthcare staff need a written copy on record with a signature to protect themselves. If you are ever instructed to share healthcare information on behalf of a patient, make sure you have them sign a release form.

Fully Editable: The form may be fully personalized to meet your individual or business needs and done as often as needed. Add/edit/personalize your business name, address and contact information, business logo, add your own images to enhance the look of your form or to display your association and certification logos, edit form fields or add your own field questions and obtain the information that you need from your patients, change text size and form ruling color to match your corporate colors or to emphasize important questions.

Printing: Form may be printed to any desktop, laser or inkjet printer, in color or black and white. Print only what you need to avoid waste. For large print volume, deliver to your local office supply store or local print shop.

Page Size: 8.5" x 11" (Standard US page size)

Program Compatibility: Form is compatible with Microsoft Word 97 and later versions for Windows version and Word for MAC 4.21 and later versions and compatible word processors such as WordPerfect, OpenOffice and LibreOffice.

What Do I Receive?

  • Form comes bundled with 
  • Microsoft Word Document file (Form) 
  • Microsoft Word Template file
  • All form assets required, such as, sample images, association logos and free ware fonts -if needed
  • Acrobat Reader PDF file
  • User Manuals.

Minimum system requirements:

  • Microsoft Word 2003 or higher

Learn more about medical practice Word forms

Software Delivery: This product is downloadable. You will receive the link to download your form by e-mail link as soon as purchase is approved by online processor. Purchases made using 2CheckOut payment processor will take about thirty minutes to be processed; PayPal orders are delivered immediately. If you do not receive expected e-mail, please be sure to check/search your junk or bulk email folders for the email from SnappyFORMS. 

Note: Sample company information displayed on forms such as business name, logo and other images may be replaced with your own image(s) and are only representative of what your form may look like after editing/customizing.

Trademarks: All product names, logos, and brands are property of their respective owners. All company, product and service names used in this website are for identification purposes only. Use of these names, logos, and brands does not imply endorsement. Apple, Mac, Macbook and iMac are trademarks of Apple, Inc., registered in the U.S. and/or other countries. Microsoft, Word are either registered trademarks of Microsoft Corporation in the U.S. and/or other countries.

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