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Medical Record Release Form - University of Utah Health Care - healthcare utah 2025

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The document is a Patient Authorization form for the disclosure of protected health information. It allows patients to authorize specific healthcare providers or facilities to disclose their medical records to designated individuals or organizations. The form includes sections for patient identification, details of the information to be disclosed, purpose of disclosure, and conditions regarding revocation and confidentiality. It emphasizes the patient's rights regarding their medical information and outlines potential charges for obtaining this information.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (26 Votes)
2016	4.8 Satisfied (246 Votes)
2006	3.8 Satisfied (30 Votes)

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How to get medical records in Utah?

Copies of medical records can be sent to another healthcare provider free of charge. Ask your provider to request your records from Intermountain directly for the fastest processing. If you submit your own request, be sure to indicate on the form that the purpose is for CONTINUITY OF CARE.

What is the purpose of a medical release form?

As the primary purpose of a medical record authorization is to protect the patients privacy and you against any litigation, any medical record that you accept or have your patient sign must contain the necessary parts that can hold up in court.

How long is a release authorization good for?

The patient may enter the date he/she wants the authorization to expire. The patient may enter an expiration event. The patient may enter a date range of information to be shared. If no expiration date is specified, this authorization is good for 12 months from the date signed in Section IX.

What is medical records release authorization?

A Privacy Rule Authorization is an individuals signed permission to allow a covered entity to use or disclose the individuals protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

What does authorization to release mean?

Authorization to release information means a written statement, signed and dated by the person empowered to authorize release of confidential information.

What is release of information in healthcare?

What Is the Release of Information in Healthcare? Release of information (ROI) allows patients to release information from their medical records to authorized individuals or organizations.

What type of consent needs to be obtained for the release of medical records?

If signed authorization is not provided, request one, including requests directly made by patients. When a third-party request is received, obtain informed consent to release the record from the patient, even if the request includes a signed authorization.

How to request medical records at the University of Utah?

Requesting Medical Records Patients can request their records through MyChart. Login to MyChart. Select Health. Select Medical Records Request Form.

Medical Record Release Form - University of Utah Health Care - healthcare utah 2025

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