Medical Records Release Form
The blank medical release form gives a patient the right to hand over his or her private records to someone else by the authorization of this document.
The patient may grant all or part of his or her documents including:
- Admission history and physical
- Discharge summary
- Office Notes
- Outpatient records
- Psychiatric and other mental health records
- Records relating to drug or alcohol abuse (must specify the extent or nature of the records to be released).
- Medication administration logs, dietary logs, staff contact or service logs, and other records that may not be part of my individual medical record, but which contain information relating to me.
- Lab reports.
- Radiological images
- Consultation notes or reports.
- Complaints or grievances filed with responses or dispositions.
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