Medical Records Release Authorization Form

Streamline Medical Records Requests with a Professional Authorization Form

Managing medical records requests can be time-consuming and complex, especially when you need to ensure compliance with privacy regulations. This Medical Records Release Authorization Form template from Paperform provides a secure, professional solution for healthcare providers, clinics, hospitals, and medical practices that need to process patient record requests efficiently.

Built for Healthcare Workflows

Whether you're a medical office manager, healthcare administrator, or records department staff member, this template captures all the essential information you need: patient identification details, specific records being requested, relevant date ranges, and authorized recipient information. The structured format ensures nothing is missed while maintaining a patient-friendly experience.

Secure Data Collection & Compliance Support

While Paperform is not HIPAA compliant, this template is designed with privacy best practices in mind to help you collect authorization details securely. You can embed this form directly on your patient portal or website, then export submissions to your secure EHR or records management system. Combined with Stepper (stepper.io), you can automate the routing of approved requests to your records team, trigger notification emails, and update your internal tracking systems—all without manual data entry.

Professional, On-Brand Patient Experience

With Paperform's doc-style editor, you can customize this template to match your practice's branding, add your logo, adjust colors and fonts, and include any specific consent language required by your organization. The clean, accessible layout makes it easy for patients or their authorized representatives to complete the form accurately.

Perfect for Healthcare Providers

This template is ideal for medical practices, dental offices, outpatient clinics, hospitals, specialty practices, and any healthcare organization that handles medical records release requests. Save time, reduce errors, and provide a better patient experience with a form that works as hard as you do.