Rare Disease Medical Records Request Form

Managing rare disease diagnosis and treatment coordination requires seamless access to comprehensive medical records across multiple specialists and institutions. This Rare Disease Medical Records Request Form template helps patients, caregivers, and healthcare coordinators efficiently request and transfer critical medical documentation for genetic testing results, nationwide specialist consultations, clinical trial eligibility screening, and patient registry enrollment.

Streamline Complex Medical Record Coordination

Rare disease patients often work with multiple specialists across different healthcare systems, making medical record coordination uniquely challenging. This template simplifies the process by capturing all necessary patient information, authorization details, and specific record requirements in one organized submission. Whether you're coordinating care between genetic counselors, rare disease specialists, or research institutions, this form ensures nothing falls through the cracks.

Built for Healthcare Providers and Patient Advocates

Designed specifically for rare disease clinics, genetic testing laboratories, patient advocacy organizations, and specialty care coordinators, this form template addresses the unique documentation needs of rare disease diagnosis and management. It includes fields for genetic testing results, imaging studies, pathology reports, and specialist consultation notes—all critical for accurate diagnosis and treatment planning.

Automate Follow-Up with Stepper

Connect this form to Stepper to automate your medical records workflow. Set up automation to send confirmation emails, route requests to the appropriate records department, track fulfillment status, and notify patients when records are ready. You can even create multi-step approval processes for sensitive genetic information releases.

Secure eSignatures with Papersign

For HIPAA-compliant authorization, pair this form with Papersign to collect legally binding eSignatures on medical release forms. Transform patient submissions into formal authorization documents that meet healthcare regulatory requirements, maintaining a complete audit trail for compliance.

Paperform for Healthcare Coordination

Paperform provides healthcare organizations with SOC 2 Type II compliant, GDPR-ready form solutions that integrate seamlessly with your existing systems. While Paperform is not HIPAA compliant, it offers the professional design flexibility, conditional logic, and workflow automation that rare disease coordinators need to manage complex record requests efficiently. With native integrations to CRMs, project management tools, and cloud storage platforms, you can keep your entire care coordination team informed and organized.