Medical Release Form Template

How to use this medical release form template

Step 1: Customize

Click on “Use this template” and create a free account in SurveySparrow. Once you create the account, the template will instantly open in the builder. Use builder features to customize the template for your needs. Rephrase the text, add or remove form fields, and change the colors.

Step 2: Integrate

SurveySparrow can be connected to 20+ tools and apps for enhanced workflow creation. For instance, you can connect with Google Sheets, and collect every response in your sheet instantly. Access the sheet from the integration tab itself. Choose the tool of your choice and connect with it.

Step 3: Share

Once you build the form you want, use multiple sharing features. You can share this form through email, SMS, WhatsApp, QR Code, and direct link. For each type of share, you can track the responses in the dashboard.

That’s it! It’s that simple to use it.

HIPAA Compliant features of SurveySparrow

Access Control

SurveySparrow provides multi-layered access control, ensuring that only authorized personnel can access sensitive health data. This is achieved by allowing different access levels for owners, admins, and contributors, each with specific roles and access permissions.

Encryption

The platform uses Advanced Encryption Standard (AES) with 256-bit keys for encrypting data both in transit and at rest. This high level of encryption guarantees the security of data, preventing unauthorized access.

Audit Controls

SurveySparrow has robust audit trail policies in place, which monitor all activities within the system. These logs include user IDs, timestamps, event details, and origins, helping to detect and alert any suspicious activities.

Person or Entity Authentication

The platform has stringent measures for verifying the identity of users, ensuring secure access to electronic Protected Health Information (ePHI).

Transmission Security

Data transmission is secured using HMACSHA-256 message authentication codes and encrypted connections, ensuring that data is transmitted securely.

Disaster Recovery Plan

SurveySparrow has an effective disaster recovery plan to ensure the continuity of business operations and secure recovery of critical data in case of a disaster.

Business Associate Contracts

The platform conducts thorough due diligence with third-party vendors or contractors to ensure they meet the same high standards of security, especially when handling PHI.

What are the purposes of using this medical release form template?

Privacy and Consent

The form is primarily used to ensure that a patient's medical information is kept private and only shared with their consent. It helps to comply with laws like the Health Insurance Portability and Accountability Act (HIPAA) in the United States, which protects patient confidentiality.

Specifying Information

The form typically specifies what medical information can be released, to whom, and under what circumstances. This might include medical records, treatment information, or diagnostic results.

Emergency Situations

In some cases, individuals might fill out a medical release form to allow specific medical details to be shared during emergencies, especially when they are unable to communicate their health needs themselves.

Legal and Medical Procedures

These forms are also used in legal settings, such as personal injury lawsuits, where medical records may be needed to support a case. Additionally, they are used in situations where minors are involved, and parents or guardians need to authorize medical treatment or the release of medical information to schools, sports teams, or other entities.

Who needs a medical release form?

Healthcare Providers

Doctors, specialists, or hospitals that might need access to a patient’s medical history to provide appropriate care, especially when the patient is seeing multiple healthcare professionals.

Insurance Companies

Health insurance providers might require access to medical records to process claims, determine coverage, or manage costs associated with medical treatments.

Legal Representatives

Lawyers or legal firms may need medical records to support cases involving personal injury, medical malpractice, or other legal issues where health information is relevant.

Family Members or Caregivers

Family members or designated caregivers may need access to medical information to assist in making healthcare decisions, especially for minors or individuals who are incapacitated.

Schools and Educational Institutions

Schools may require medical information to manage health needs or emergencies involving students, especially in the case of children with chronic conditions or special needs.

Employers

In some instances, employers might need access to medical information for purposes related to workplace accommodations or compliance with occupational health and safety regulations.

Government Agencies

Certain government agencies may require health information for public health tracking, benefits administration, or compliance with regulations.

Research Organizations

Researchers might be granted access to medical information for scientific studies, with patient consent, particularly in de-identified forms to ensure privacy.