Standard Release Of Information Form

Standard Release Of Information Form for the United States

Standard Release Of Information Form Template for United States

Your data doesn't train Genie's AI

You keep IP ownership of your information

Generate a Bespoke Document

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Download a Standard Template

Get our United States-compliant Standard Release Of Information Form

4.6 / 5

4.8 / 5

Alternatively: Run an advanced review of an existing
Standard Release Of Information Form

Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.

What is a Standard Release Of Information Form?

The Standard Release of Information Form is a crucial document used when there's a need to share protected personal information between authorized parties. This form, governed by U.S. federal and state regulations, ensures compliance with HIPAA and other privacy laws while protecting the rights of the information owner. It's commonly used in healthcare settings but extends to educational institutions, insurance companies, and legal services. The form typically includes specific details about the information being released, the purpose of the release, time limitations, and the rights of the individual providing consent. It serves as both a legal authorization and a record-keeping tool for tracking information disclosure.

What sections should be included in a Standard Release Of Information Form?

1. Patient Information: Full legal name, date of birth, contact information, and other identifying details of the patient

2. Information Provider: Details of the healthcare provider/entity releasing the information including name, address, and contact information

3. Information Recipient: Details of the person/entity authorized to receive the information including name, address, and contact information

4. Information to be Released: Specific description of what information is authorized for release, including date ranges and types of records

5. Purpose of Release: Stated reason for information disclosure (e.g., continuing care, legal purposes, insurance)

6. Duration: Expiration date or event for the authorization, as required by HIPAA

7. Rights Statement: Statement of patient rights including right to revoke authorization and right to refuse to sign

8. Signatures: Patient or authorized representative signature block with date and relationship to patient if applicable

What sections are optional to include in a Standard Release Of Information Form?

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

2. Witness Section: Space for witness signature when required by state law or organizational policy

3. Payment Information: Details about any fees associated with records release and payment methods accepted

What schedules should be included in a Standard Release Of Information Form?

1. State-Specific Addendum: Additional provisions and requirements specific to the state where the release is being executed

2. Records Checklist: Detailed itemized checklist of specific records being requested or released

3. Fee Schedule: Comprehensive breakdown of applicable fees for record copying and release services

Authors

Alex Denne

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

Relevant legal definitions

Business Associate

Clauses

Relevant Industries

Healthcare
Insurance
Education
Legal Services
Social Services

Relevant Teams

Medical Records
Compliance
Legal
Administrative Services
Human Resources
Information Technology

Relevant Roles

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

Find the exact document you need

No matches found.

Vital Records Authorisation Form

A U.S. legal form authorizing the release of vital records while ensuring compliance with federal and state privacy regulations.

51��Ƶ����

How Cambridge United Uses Genie AI to Speed Up Player Signings and Slash Legal Costs

Generate a Bespoke Document

Download a Standard Template

What is a Standard Release Of Information Form?

What sections should be included in a Standard Release Of Information Form?

What sections are optional to include in a Standard Release Of Information Form?

What schedules should be included in a Standard Release Of Information Form?

Authors

Alex Denne

Find the exact document you need

Vital Records Authorisation Form

Tenant Authorisation Form

Parental Authorisation Form

Overtime Authorisation Form

Return Merchandise Authorisation Form

Non Borrower Credit Authorisation Form

Manufacturer Authorisation Form

Disbursement Authorisation Form

Appointment Of Authorised Representative Form

Pet Care Emergency Authorisation Form

Vendor Direct Deposit Authorisation Form

Deposit Authorisation Form

Medical Authorisation Form For Adults

Authorisation Of Release Of Unemployment Records Form

Electronic Funds Transfer Authorisation Form

Return Authorisation Form

Payroll Authorisation Form

Check Authorisation Form

Authorisation For Release Of Records

Medical Records Release Authorisation Form

Owner Authorisation Form

Payoff Authorisation Form

Agent Authorisation Form

Pre Employment Background Check Authorisation Form

Pre Authorised Debit Form

Payroll Deduction Authorisation Form

Third Party Authorisation Form

Authorised Representative Form

Background Check Authorisation Form

Direct Deposit Authorisation Form

Direct Deposit Enrolment Form

Authorization To Release A Medical Certificate

Voided Check Form

Time Off Request Form

Ach Form

Credit Reference Request Form

Overtime Form

Representative Form Ircc

Direct Debit Authorisation Form

Eft Authorization Form

Client Authorisation Form

Collection Authorisation Form

Direct Credit Authorisation Form

Written Authorization Form

Workers Compensation Authorization Form

Workers Comp Authorization Form

Work Authorization Letter

Vendor Ach Form

Vendor Ach Authorization Form

Travel Consent Form For Minor With Notary

Third Party Release Form

Third Party Credit Card Authorization Form Hotel

Third Party Credit Card Authorization Form

Third Party Authorization Form

Tenant Release And Consent Form

Tenant Authorization Letter

Tenant Authorization Form

Temporary Medical Consent Form For Minor

Student Authorization To Hold Excess Funds

Special Power Of Attorney For Authorized Representative

Special Power Of Attorney Authorization Letter

Social Media Consent Form For Patients

Simple Release Of Information Form

Simple Authorization Letter

Signature Authorization Form

Return Merchandise Authorization Form

Return Authorization Form

Resolution Letter To Sign On Behalf Of Company

51��Ƶ��

�ұ�Ծ��’s Security Promise