Records Release Form - CSHPnet 2025

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What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.
Archiving: The act of determining and removing patient records from the records storage room that have been dormant/inactive for two or more years (24 months from the date of the last entry in the record) to the archives.
The medical record contains valuable information about a patient's medical history and individual clinical interactions. Such information supports the ongoing care for the patient by the physician and other providers.
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Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.
What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.
Generally, an authorization provides the authority for a doctor's release of PHI for specified purposes, which are generally other than treatment, payment, or healthcare operations, or, to disclose protected health information to a third party specified by the individual.
Consent to Release Information The name of the person or entity authorized to make the request (usually the patient) The complete name of the person or entity to receive the protected health information (PHI) A specific description of the information to be used or disclosed, including the dates of service.
This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows the Health Plan (your health insurance carrier or HMO) to release your protected health information to a person or organization that you choose.

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