Resources

Forms Download

Below you will find many authorizations and forms required to retrieve records from healthcare facilities, as well as from several government agencies. All of these forms can be printed or saved into your directory for future use. We like to keep our customers current with the most recent forms, so if you have one you would like posted or need a form and can't find it, please email us at contact@medrecs.com . We will just keep adding to the list.

Please use this form when requesting records by either mail or fax. This form must be accompanied by a Stipulation or authorization. If you would like to request records online, you may create an account to utilize all of Medrecs’ online services.

Medrecs Record Request Form


Medical Authorizations and Stipulation

MEDRECS STIPULATION FOR RELEASE OF MEDICAL RECORDS- Template

MEDRECS STIPULATION FOR RELEASE OF EMPLOYMENT RECORDS- Template

MEDRECS STIPULATION FOR RELEASE OF SCHOLASTIC RECORDS- Template

Areas highlighted in red are editable. If you have any questions regarding the use of the Stipulation template, please email contact@medrecs.com or call 206-624-1420 x: 273.

MEDRECS HIPAA AUTHORIZATION (WORD)

MEDRECS HIPAA AUTHORIZATION (PDF)

HIPAA Compliant Release of Information Authorization which contains content and wording for the release of sensitive information. The authorization is valid for 90 days after date of signature.

Kaiser Permanente Release of Medical Information
Authorization for any Kaiser Permanente location within Washington or Oregon

Kaiser Permanente Authorization- Southern California

Kaiser Permanente Authorization- Northern California

Group Health Cooperative Authorization Form

New York State HIPAA Authorization

Kroger-Fred Meyers Authorization


Governmental Authorizations

VA Medical Release

DSHS Release Form

Internal Revenue Service Release Form 4506

Department of Licensing Public Disclosures

L&I Release of Public Records

L&I Release of Claim Information

SSA- Detailed Earnings Release

SSA Form 1696- Appointment of Representative

Social Security Consent for Release of Information

Authorization for Medical Records of Dependants of Military Personnel

Request Pertaining to Military Records SF180

Questionnaire About Military Service NA13075

King County Mental Health and Chemical Abuse Authorization

Naval Hospital Authorization DD2870

MEDICARE Authorization Form CMS10106

Washington State HCA Authorization

Employment Security Department Request


Miscellaneous Forms

Employment Release

School Records Release

Declaration of Custodian of Records

Letter of Representation- Law Firms

Letter of Representation- Insurance

Washington State Patrol Public Record Disclosure Request

Washington State Patrol Collision Report Request

Medrecs Tips to Remember