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The document outlines the authorization process for patients to request the release of their medical records from Michigan Medicine's Health Information Management (HIM) Release of Information (ROI) Unit. It includes details on how to complete the request form, delivery methods, purposes for disclosure, associated fees, and instructions for submitting requests. The document emphasizes that authorization is voluntary and provides information on revocation of consent and privacy considerations.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (67 Votes)
2020	4.3 Satisfied (137 Votes)
2019	4.3 Satisfied (53 Votes)
2018	4.1 Satisfied (68 Votes)
2015	4.3 Satisfied (264 Votes)
2012	4.4 Satisfied (60 Votes)

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What is a record release form?

A Medical Records Release is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patients medical records, either to the patient, a third party (such as an employer or insurance company), or both.

What is the purpose of a release form?

How Do You Write a Media Release Form? Name of the parties involved, i.e., releasor and releasee. Detailed information about the project. Explicit information of the permissions granted. Any special considerations, including payment obligations or credit, if any. A space for all parties to sign.

What is record release?

A patient medical records release form is a legal document that empowers patients to control the authorized sharing of their confidential health information while ensuring compliance with privacy laws and regulations.

What is a record of release?

Medical records release forms establish and document a patients consent for their health information to be shared. They provide legal authorization for providers to release records to specific recipients, such as medical facilities, insurance companies, or legal representatives.

What is the purpose of a release?

Releases are routinely used by photographers, in film production, by documentary filmmakers, or by radio and music producers when they photograph, film, video or record the voice or performance of individuals to be sure that the person consents or will not later object to the material being used for whatever purpose

What are the reasons for records release?

There are several common reasons for the release of information, including medical treatment purposes, medical billing, insurance billing, health studies, legal proceedings, and marketing purposes. Sometimes a third party like an insurance company or an attorney needs to request your medical information.

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