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- Ambulance Transfer Form
- Authorization for Disclosure of Protected Health Information
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- Body Measurement Form
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- Caregiver Consent Form
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- Child Care Emergency Form
- Child Health Survey
- Child Intake Form
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- Client History Form
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- Dental Enrollment Form
- Dental Estimate Form
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- Dental Insurance Form
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- Dental Procedure Medical History Form
- Dental Records Release Form
- Dental Referral Form
- Dental Reimbursement Form
- Dental Screening Form
- Dental Treatment Consent Form
- Dental Treatment Plan Form
- Dentistry Contact Form
- Disability Verification Form
- Doctor Appointment Form
- Doctor Diagnosis Form
- Doctor Referral Form
- Drug Prior Authorization Request Form
- Emergency Contact Form
- Emergency Information Form
- Endodontist Patient Registration Form
- Endodontist Referral Form
- Enrollee Prescription Drug Claim Form
- Facial Intake Form
- First Aid Checklist Form
- First Aid Quiz
- Flu Vaccine Consent Form
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- General Dentist Patient Registration Form
- General Surgery Consent Form
- Health Assessment Questionnaire
- Health Checklist Form
- Health Evaluation Form
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- Health Insurance Evaluation Survey
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- Health Insurance Marketplace Statement
- Health Screening Form
- Health Survey
- Home Delivery Pharmacy Prescription Order Form
- Hospital Admission Form
- Hospital Discharge Form
- Hospital Evaluation Form
- Hospital Patient Satisfaction Survey
- Hospital Registration Form
- Hospital Visitation Form
- Immunization Exemption Form
- Immunization Record Form
- Immunization Record Request Form
- Immunization Waiver Form
- Indemnity Form
- Informed Consent Form
- Laboratory Test Request Form
- Massage Consent Form
- Massage Health History Form
- Massage Therapy Consent Form
- Massage Therapy Intake Form
- Maternity Claim Form
- Medicaid Application Form
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- Medicaid Transportation Form
- Medical Card Application Form
- Medical Certificate Form
- Medical Consultation Form
- Medical Declaration Form
- Medical Examination Form
- Medical Examination Report Form
- Medical History Form
- Medical Information Form
- Medical Insurance Form
- Medical Order Form
- Medical Permission Form
- Medical Record Audit Form
- Medical Record Transfer Request
- Medical Records Request Form
- Medical Reimbursement Bill Form
- Medical Reimbursement Claim Form
- Medical Release Form
- Medical Summary Form
- Medical Travel Form
- Medicare Application Form
- Medication Administration Record
- Medication Disposal Form
- Medication List Form
- Member Reimbursement Form
- Mental Health Intake Form
- Mental Health Survey
- Newborn Questionnaire
- Nursing Assessment Form
- Nursing Home Application Form
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- Occupational Therapy Progress Note
- Online Bill Payment
- Online Medical Questionnaire
- Ophthalmology Referral Form
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- Organ and Tissue Donation Form
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- Patient Demographic Form
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- Patient Engagement Survey
- Patient Exit Survey
- Patient Health Questionnaire
- Patient History Form
- Patient Intake Form
- Patient Monitoring Form
- Patient Note Entry Form
- Patient Nutrition Assessment Form
- Patient Pain Assessment Form
- Patient Progress Tracking
- Patient Registration Form
- Patient Revocation Request Form
- Patient Satisfaction Survey
- Patient Survey Questionnaire
- Pediatric Consent Form
- Pedodontic Patient Information Form
- Periodontal Referral Form
- Permission To Treat Form
- Personal Representative Request
- Pharmacy Complaint Form
- Pharmacy Registration Form
- Physical Clearance Form
- Physical Exam Form
- Physical Therapy Evaluation Form
- Physician Referral Form
- Physician Satisfaction Survey
- Physician Verification Form
- Police Medical Questionnaire
- Prescription Drug Claim Form
- Prescription Form
- Prescription Refill Request Form
- Proof Of Immunization Form
- Provider Satisfaction Survey
- Psychiatric Evaluation Form
- Psychological Assessment Form
- Psychology Intake Form
- Psychology Referral Form
- Psychotherapy Intake Form
- Referral Request Form
- Request a Routine Medical Appointment
- Request for Access to Protected Health Information
- Request for Accounting
- Request for Confidential Communications
- Request for Diagnosis and Treatment Code Information Form
- Request for Restriction of Use and Disclosure of PHI
- Request Routine Dental Appointment Form
- Request to Amend Protected Health Information
- Request to Inspect a Copy of Clinical Record
- Request to Obtain a Copy of Clinical Record
- Request to Restrict the Use of Confidential Information
- Safety Declaration Form
- School Entry Health Form
- School Medication Form
- School Medication Record
- Self Referral Form
- Social Psychology Survey
- Social Work Intake Form
- Sports Physical Form
- Sports Therapy Consultation Form
- Statement of Disagreement
- Student Health Record Form
- Student Insurance Claim Form
- Test Report Form
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Medical Records Release Form Template
Add this medical records release form template to your website with 123FormBuilder. Edit the template with simple drag & drop, no coding skills needed.
- 100 submissions per month
- Digital signatures
- Use your own logo and branding
- Share and publish it anywhere
- Notification emails
Join 1.5 million happy customers that build forms & surveys with 123FormBuilder
Customize template
See howMedical records release requests should be concise, clear and clean. This ready-made template saves you a lot of time and is easy to modify without writing any code. Drag & drop additional fields if you need to, add your medical facility logo and make use of the conditional logic option. Use a reCaptcha, secure submissions and enable form password protection.
Publish template
See howOur medical records release template is mobile-responsive and can be accessed from any device. When you are satisfied with the look and contents of your records release form, you can hit the Publish tab in your editor and have your form easily embedded on your website. Only a copy paste is required from your part.
Collect & manage data
See howHandling confidential healthcare information is a big responsibility. Submissions on the medical records release form are streamlined over a secure SSL connection and stored in an encrypted repository. Upon request, you can upgrade your form to get HIPAA compliance. Data entries can be exported in CSV, Excel or PDF, and also connected to Google Drive and other third-party apps of your choice.
Optimize your flow
See howForget the paper form mess. Speed up the data collection process with email or SMS alerts each time someone completes the form. Create beautiful and functional medical forms online using 123FormBuilder premade templates.
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