Pediatric Medical Records Release Form for Divorced Parents

Managing pediatric medical records for divorced or separated parents requires clear documentation, custody verification, and proper consent protocols. This Pediatric Medical Records Release Form streamlines the process for healthcare providers, schools, and families navigating custody arrangements while ensuring compliance with HIPAA and state regulations.

Why Healthcare Providers Need This Form

Pediatric practices, hospitals, and school health offices regularly handle requests from divorced parents seeking their child's medical records. This form helps you:

• Verify legal custody and decision-making authority before releasing sensitive health information
• Document consent from both parents when required by custody agreements or state law
• Process immunization records for school enrollment efficiently
• Maintain HIPAA compliance while respecting family court orders
• Reduce administrative back-and-forth with incomplete or unclear requests

Streamline Your Workflow with Paperform

This template captures all essential information in one place—parent information, custody documentation, consent signatures, and specific record requests including immunization histories. The clean, professional design ensures families understand what's required, while conditional logic shows only relevant questions based on custody arrangements.

Once submitted, you can use Stepper (stepper.io) to automatically route requests to your medical records team, notify the second parent if dual consent is needed, and track the fulfillment process. Connect to your practice management system or create a secure audit trail in your existing tools—no manual data entry required.

For practices needing secure signatures on file, Papersign (papersign.com) lets you turn this form into a legally binding authorization document with eSignatures from one or both parents, keeping everything connected to the original request for complete compliance documentation.

Whether you're a pediatric clinic, family medicine practice, school nurse, or hospital records department, Paperform helps you handle these sensitive requests professionally while protecting both the child's privacy and your practice's compliance standards.