AUTHORIZATION TO RELEASE MEDICAL RECORDS FAX: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out AUTHORIZATION TO RELEASE MEDICAL RECORDS FAX

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name, date of birth, and account number in the designated fields at the top of the form.
In section 1, select the type of information you wish to authorize for release by checking the appropriate boxes. If you choose 'Other', provide a detailed description in the space provided.
For section 2, fill in the names and addresses of individuals or organizations that will receive this information. Ensure all contact details, including phone and fax numbers, are accurate.
In section 3, indicate the purpose for which this information is being disclosed by checking one of the options or providing a specific reason if 'Other' is selected.
Review and complete sections 4 through 8 regarding authorization statements and signatures. Make sure to sign and date where indicated.

Start using our platform today to easily fill out your AUTHORIZATION TO RELEASE MEDICAL RECORDS FAX for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is a form for authorization to release medical records?

A HIPAA release form is a document that when signed allows healthcare providers to share a patients protected health information (PHI) with specified individuals or organizations, according to the details stipulated in the form.

What form is used to allow the release of their medical records?

A HIPAA release form is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

How do you write an authorization letter for medical records release?

Releasing Your Medical Records Format your letter. You can set up your letter like a standard business letter. Draft the authorization. State the time period for disclosures. Identify what information to release. Identify how long your authorization is effective. Include other general provisions. Sign the release.

Is it legal to fax medical records?

Can You Fax Medical Records Under HIPAA? Yes. HIPAA does not prohibit faxing, but it requires that certain safeguards are in place when transmitting Protected Health Information (PHI).