Medical Records Request for Clinical Trial Enrollment

Streamline Clinical Trial Enrollment with Medical Records Request Forms

Enrolling patients in clinical trials requires comprehensive medical documentation to verify eligibility and establish baseline health parameters. This Medical Records Request for Clinical Trial Enrollment form template simplifies the complex process of gathering essential patient information, previous treatment records, and eligibility screening data—all in one organized, HIPAA-compliant workflow.

Built for Research Coordinators and Clinical Trial Teams

Whether you're a clinical research coordinator at a hospital, a principal investigator managing multiple trials, or a CRO supporting pharmaceutical research, this form helps you:

• Verify patient eligibility with structured screening questions tied to inclusion/exclusion criteria
• Request comprehensive medical records from healthcare providers with clear authorization
• Document baseline health assessments including vital signs, lab results, and current medications
• Capture previous treatment history to evaluate patient suitability and stratification needs

Professional, Secure, and Easy to Customize

This template is designed with the unique needs of clinical research in mind. The clean, professional layout builds trust with patients and healthcare providers, while conditional logic ensures you only collect relevant information based on trial type and patient responses. Forms can be embedded on research sites, shared via email, or accessed through secure patient portals.

With Paperform's SOC 2 Type II compliance and data security features, you can confidently collect sensitive health information while maintaining regulatory standards. For teams managing complex clinical trial workflows, Stepper can automate the entire post-submission process—routing records to review committees, updating trial management systems, triggering follow-up communications, and maintaining audit trails for regulatory compliance.

How Healthcare Organizations Use This Template

Clinical research organizations, academic medical centers, pharmaceutical companies, and hospital research departments use this form to accelerate trial enrollment while maintaining data integrity. By replacing paper-based records requests with a structured digital form, research teams reduce data entry errors, speed up eligibility determination, and create complete documentation packages for IRB and regulatory submissions.

The form's flexibility allows you to adapt it for Phase I through Phase IV trials across therapeutic areas—from oncology and cardiology to neurology and rare diseases—making it an essential tool for any organization conducting patient-centered research.