Medical Release Letter - United States

Medical Release Letter for the United Kingdom

Medical Release Letter Template for United States

A Medical Release Letter is a formal document that complies with U.S. federal HIPAA regulations and state-specific privacy laws, authorizing the release of an individual's protected health information. This document specifies what medical information can be shared, with whom, for what purpose, and for how long. It includes mandatory elements such as patient identification, specific authorization language, and clear documentation of the scope of information to be released.

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What is a Medical Release Letter?

A Medical Release Letter is essential in healthcare settings where protected health information needs to be shared between different parties. This document, governed by HIPAA regulations and state-specific requirements in the United States, serves as legal authorization for the transfer of medical records. It's commonly used when patients need their records sent to new healthcare providers, insurance companies, or legal representatives. The letter must include specific elements required by law, such as clear patient identification, explicit description of information to be released, designated recipients, and temporal limitations of the authorization.

What sections should be included in a Medical Release Letter?

1. Patient Information Block: Full legal name, date of birth, address, contact information, and medical record number of the patient

2. Authorization Statement: Clear and explicit statement of consent authorizing the release of medical information

3. Information Details: Specific description of what medical information is authorized for release, including date ranges and types of records

4. Recipient Details: Complete information about the person or organization authorized to receive the medical information

5. Duration and Expiration: Specific timeframe for which the authorization is valid, including expiration date or event

6. Rights Statement: Statement of patient's rights including right to revoke authorization and right to refuse to sign

7. Signatures Block: Space for patient or authorized representative signature, date, and any required witness signatures

What sections are optional to include in a Medical Release Letter?

1. Special Categories Authorization: Additional specific authorization for sensitive information such as mental health records, HIV status, or substance abuse treatment

2. Purpose of Release: Statement describing the specific purpose for releasing the medical information

3. Electronic Delivery Authorization: Specific authorization for electronic transmission of records, including email or portal access

4. Re-disclosure Notice: Statement regarding potential re-disclosure of information by recipient and limits of privacy protection after release

What schedules should be included in a Medical Release Letter?

1. Identity Verification Documents: Attached copies of government-issued ID or other required verification documents

2. Legal Authority Documentation: Attached power of attorney, legal guardian documentation, or other proof of legal authority to request records

3. Specific Records List: Detailed itemized list of specific records being requested, if extensive or complex

4. State-Specific Forms: Any additional state-required forms or documentation for medical release

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Cost

Free to use

Relevant legal definitions

Business Associate

Clauses

Relevant Industries

Healthcare
Insurance
Legal Services
Education

Relevant Teams

Medical Records
Compliance
Legal
Administration
Privacy Office

Relevant Roles

Medical Records Administrator
Privacy Officer
Healthcare Administrator
Compliance Manager
Medical Office Manager

Industries

HIPAA: Health Insurance Portability and Accountability Act of 1996 - Core federal legislation governing medical privacy, including Privacy Rule requirements, Security Rule compliance, patient rights regarding Protected Health Information (PHI), and requirements for valid authorization

State Privacy Laws: State-specific legislation that may provide additional privacy protections beyond HIPAA, including specific requirements for medical information release and varying age of consent laws by state

42 CFR Part 2: Federal regulations providing special requirements and additional privacy protections for substance abuse and addiction treatment records

Americans with Disabilities Act (ADA): Federal civil rights law that includes confidentiality requirements and non-discrimination provisions for medical information related to disabilities

Mental Health Laws: State-specific mental health privacy laws providing special protections for psychiatric records and mental health information

FERPA: Family Educational Rights and Privacy Act - Federal law governing privacy of educational records, including special requirements for student health information when medical records are part of educational records

Patient Identification Requirements: Legal requirements for properly identifying the patient in medical release documentation to ensure accurate and secure information transfer

Information Scope Requirements: Legal requirements for specifically describing what medical information is to be released and to whom it will be released

Temporal Requirements: Legal requirements regarding expiration dates or events for the medical release authorization

Revocation Rights: Legal requirements to inform patients of their right to revoke medical information release authorization

Re-disclosure Provisions: Legal requirements to inform patients about potential re-disclosure of their medical information by recipients

Authentication Requirements: Legal requirements for signatures, witnesses, or notarization of medical release documents, which may vary by state

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What is a Medical Release Letter?

What sections should be included in a Medical Release Letter?

What sections are optional to include in a Medical Release Letter?

What schedules should be included in a Medical Release Letter?

Authors

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