Free Medical Disclosure Form Template

Tips For Using the Medical Disclosure Form Template

Medical disclosure forms are documents that give patients control over who has access to their medical information. This document specifies who can access their medical information and permits healthcare providers to share medical information.

Let’s look at how to create and share medical disclosure forms using Formplus templates.

What Is a Medical Record Release Form?

A medical release form, also known as a medical disclosure form, is a legal document that allows a patient to authorize the disclosure of their medical information to specific people or organizations.

This form contains the patient's personal and contact information, as well as the names and contact information of the parties they are sharing their medical record with.

Most patients use medical disclosure forms when they are receiving medical treatment from multiple healthcare providers or when they want to share their medical information with another person or organization, such as their workplace.

For example, a patient may want to grant their primary care physician permission to share their medical records with a specialist they are seeing for a specific condition. A patient could also wish to give their family members access to their medical information in the event of an emergency.

What Should Be Included in a Medical Disclosure Form?

• Patient Information: Patient's name, date of birth, and contact details.
• Authorized Parties: Names and contact information of the individuals or entities to whom the patient is authorizing the disclosure of their medical information.
• Scope of Authorization: Specification of the medical information the patient authorizes to be disclosed, such as medical history, lab results, or treatment plans.
• Duration of Authorization: The patient's authorization validity period. The patient could specify a time limit or leave it open until they decide to revoke the authorization.
• Signature: The patient must sign the form to indicate their consent and understanding of the terms of the disclosure.
• Witness: Most states may also require a witness to sign the form to ensure that the patient signed the form voluntarily and understand its contents.

How Do You Write a Medical Consent Form?

1. Open the "Medical Disclosure Form" from the template library.
2. Edit the form fields and questions to fit your needs.
3. Save the form.
4. Customize the form design by changing its theme, adding your logo, and more.
5. Go to settings to set up submission notifications, autoresponder, and form privacy.
6. Choose how you want to share the form- QR Code, patient’s email, or embed it on your website.
7. Monitor form submissions with notifications. This enables you to effectively respond to inquiries or requests from patients.

Conclusion

Medical disclosure forms enable patients to control access to their medical information. It also makes it easier for healthcare providers to securely exchange patient information.

With Formplus medical disclosure form template, patients can securely share their medical records. It protects patients' privacy while also streamlining the authorization process.