Authority To Release Medical And Or Hospital Records

AUTHORITY TO RELEASE MEDICAL AND/OR HOSPITAL RECORDS. This is a written authorization that allows a healthcare provider, hospital, or medical records department to release a patient’s medical information to the patient’s attorney. This form permits disclosure of records relating to diagnosis, treatment, medical opinions, billing, laboratory reports, X-rays, and hospital records, including sensitive information such as substance abuse or mental health treatment where applicable. The authorization directs that records be released only to the named attorney, and specifically instructs providers not to disclose information to insurance adjusters or other third parties without additional written consent. The form includes options to request specific categories of records and typically remains effective until revoked in writing, but no longer than one year from the date signed. www.FormsWorkflow.com