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 firstname.lastname@example.org . 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.
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 email@example.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
P.O. Box 4186
Seattle, WA 98194