Free Medical Records Release

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Patient Information

Frequently Asked Questions

Who is the Patient?"Patient" is the individual who is seeking to have Medical Records released.

Current Location of Medical Records

Organization Details

Please insert the doctor's office, clinic, hospital, etc. name here.

Frequently Asked Questions

Who is the Organization?The Organization is the entity that holds the Medical Record for the Patient, and is where this Medical Records Release should be sent. The Organization could be a doctor's office, clinic, hospital, allied healthcare clinic (such as a chiropractor, physiotherapist, or massage therapist), HMO, Medicare, or Medicaid.

Sharing Medical Records

Frequently Asked Questions

Who should have access to the medical records?The Patient’s Medical Records may be shared with other healthcare providers, and with individuals/organizations that the Patient and/or Legal Representative specify below. Common examples of non-healthcare providers that may require Medical Records include insurance companies, lawyers, employers and exercise facilities.

Medical Records Correction

Frequently Asked Questions

What should I do if there are errors within the medical records?If there are identified errors within the Patient’s existing Medical Records, you may ask for them to be corrected using this Release.

Duration of Medical Release

To prevent the unauthorized disclosure of your Medical Records in the future it highly recommended that you limit the duration of your Medical Records Release to less than two years.

Signing Details


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