Medical Release Form

This medical release form authorizes the release of specific medical information from a patient to a designated individual or organization. The form includes details about the patient, recipient, purpose of disclosure, specific information to be released, and expiration date. It outlines patient rights, including the right to revoke the authorization, and provides contact information for questions. The form also includes sections for signatures from the patient or representative, healthcare provider, and acknowledgment of receipt.

How It Works

This template has been set up as a Word document (.docx).

After purchase, you'll get access to the Word template immediately.

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FAQs

Google Docs version?

This template can easily be uploaded to use in Google Docs (via your Google Drive page).

Share with team

This purchase is for a single license for you to use with your team. If you want to share with additional teams, divisions or people from other companies, please get in touch (to discuss the extra licenses).

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Disclaimer: This template has been researched and compiled to be used as a starter template for your business. Ensure your final template meets relevant legal regulations before using it.