---
title: Medical Records Release Authorization Form Template | Paperform
description: Professional medical records request and release authorization form template. Collect patient information, record specifications, date ranges, and recipient details securely.
url: "https://paperform.co/templates/medical-records-release-authorization-form"
type: static
generatedAt: "2026-03-28T00:44:29.580Z"
---

[← Back to free form templates](/templates/)    ![Medical Records Release Authorization Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-records-release-authorization-form.png)
    [Preview](https://_preview.paperform.co/ai-template/medical-records-release-authorization-form) [Use this template for free](/create?ai-template=medical-records-release-authorization-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/) [Office Manager](/templates/role/office-manager/)[Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### 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.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Medical Records Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-records-request-form.png)

### Medical Records Request Form

A comprehensive patient-initiated form for requesting, transferring, and receiving medical records from healthcare providers with flexible delivery options.](/templates/medical-records-request-form/)
[![Nephrology Medical Records Release Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/nephrology-medical-records-release-form.png)

### Nephrology Medical Records Release Form

Request and authorize the release of nephrology treatment records including dialysis logs, kidney function tests, transplant evaluations, and vascular access documentation for patient care coordination.](/templates/nephrology-medical-records-release-form/)
[![Primary Care Physician Records Transfer Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/primary-care-physician-records-transfer-form.png)

### Primary Care Physician Records Transfer Form

A comprehensive medical records transfer form for new patients to authorize the release of their health records, including immunization history, chronic conditions, and current medications from their previous healthcare provider.](/templates/primary-care-physician-records-transfer-form/)
[![Cardiology Records Release Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/cardiology-records-release-form.png)

### Cardiology Records Release Form

Request and authorize the release of cardiology medical records including EKG results, echocardiogram reports, stress test findings, and cardiac catheterization procedure notes.](/templates/cardiology-records-release-form/)
[![Chiropractic Treatment Records Release Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chiropractic-treatment-records-release-form.png)

### Chiropractic Treatment Records Release Form

A comprehensive form for patients to authorize the release and transfer of their chiropractic treatment records, including adjustment notes, X-ray images, and diagnostic reports to referring physicians or other healthcare providers.](/templates/chiropractic-treatment-records-release-form/)
[![Endocrinology Medical Records Transfer Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/endocrinology-medical-records-transfer-request.png)

### Endocrinology Medical Records Transfer Request

A comprehensive form for requesting and transferring endocrinology medical records, including diabetes management plans, thyroid monitoring, hormone therapy documentation, and metabolic disorder tracking.](/templates/endocrinology-medical-records-transfer-request/)
[![Hospital Discharge Summary Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospital-discharge-summary-request-form.png)

### Hospital Discharge Summary Request Form

Request hospital discharge summaries and medical records for patient care coordination, insurance claims, or personal records. Includes admission details, physician information, and billing documentation requirements.](/templates/hospital-discharge-summary-request-form/)
[![Insurance Claim Medical Records Authorization Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/insurance-claim-medical-records-authorization-form.png)

### Insurance Claim Medical Records Authorization Form

A comprehensive authorization form for releasing medical records to insurance companies for claim processing. Streamlines the records request process with policy details, claim references, and specific treatment information.](/templates/insurance-claim-medical-records-authorization-form/)
[![International Medical Records Transfer Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/international-medical-records-transfer-request-form.png)

### International Medical Records Transfer Request Form

Request the transfer of medical records internationally with translation services, foreign healthcare provider verification, and travel medicine documentation coordination.](/templates/international-medical-records-transfer-request-form/)
[![Interventional Radiology Procedure Records Release Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/interventional-radiology-procedure-records-release-form.png)

### Interventional Radiology Procedure Records Release Form

Request and authorize the release of interventional radiology procedure records, including image-guided biopsies, embolization procedures, catheter placements, and follow-up imaging documentation.](/templates/interventional-radiology-procedure-records-release-form/)
[![Medical Imaging Records Transfer Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-imaging-records-transfer-request-form.png)

### Medical Imaging Records Transfer Request Form

Streamline the process of requesting and transferring medical imaging records with options for DICOM formats, delivery methods, and modality selection.](/templates/medical-imaging-records-transfer-request-form/)
[![Medical Records Amendment Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-records-amendment-request-form.png)

### Medical Records Amendment Request Form

A HIPAA-compliant form for patients to request amendments or corrections to their medical records, including documentation upload and acknowledgment of their right to amend under HIPAA.](/templates/medical-records-amendment-request-form/)