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Release Of Records Form for the United Kingdom

Release Of Records Form Template for United States

A Release of Records Form is a legal document used in the United States to authorize the transfer of confidential information from one party to another. This document ensures compliance with federal and state privacy laws, including HIPAA, FERPA, and other relevant regulations. It provides detailed authorization for the release of specific records, outlines the purpose and duration of the authorization, and includes necessary privacy protections and disclaimers.

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Release Of Records Form

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What is a Release Of Records Form?

The Release Of Records Form serves as a critical document for managing the authorized disclosure of confidential information while maintaining compliance with U.S. privacy laws. This document is essential when any party needs to obtain records that are protected by privacy regulations, such as medical records (HIPAA), educational records (FERPA), or other confidential information. The form typically includes specific details about what records can be released, to whom, for what purpose, and for how long the authorization remains valid. It's designed to protect both the record holder and the subject of the records while facilitating necessary information sharing.

What sections should be included in a Release Of Records Form?

1. Identification of Parties: Details of the record holder and the requesting party

2. Purpose of Release: Clear statement of why the records are being requested and how they will be used

3. Records Description: Specific description of which records are to be released

4. Duration of Authorization: Time period for which the release authorization is valid

5. Authorization Statement: Explicit consent for release of specified records

6. Signature Block: Space for signatures, dates, and any required witnesses

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

1. Revocation Rights: Statement of right to revoke authorization, used when required by applicable laws

2. Re-disclosure Notice: Warning about potential re-disclosure of information, used for HIPAA-covered records

3. Special Authorizations: Additional authorizations for sensitive information (HIV, mental health, etc.), used when such records are involved

4. Payment Notice: Information about any fees associated with records release, used when applicable

What schedules should be included in a Release Of Records Form?

1. Records List: Detailed inventory of specific records to be released

2. Fee Schedule: Breakdown of any applicable fees for records release

3. Authorization Requirements: List of specific requirements for different types of records

Authors

Alex Denne

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

Jurisdiction

United States

Document Type

Authorization Form

Cost

Free to use
Clauses




















Industries

HIPAA: Health Insurance Portability and Accountability Act of 1996 - Governs medical records privacy, includes Privacy Rule requirements, Security Rule compliance, and patient rights regarding their health information

FERPA: Family Educational Rights and Privacy Act - Controls educational records privacy, including student privacy rights, parental access rights, and educational institution obligations

Privacy Act of 1974: Federal legislation governing federal agency records, including personal information protection and disclosure requirements

State Privacy Laws: State-specific privacy regulations that may have additional requirements, affecting retention periods and consent requirements

GDPR Compliance: European Union data protection regulation that may apply if records involve EU residents, including data protection requirements and right to be informed

Industry-Specific Regulations: Including Graham-Leach-Bliley Act for financial records, labor laws for employment records, and FCRA for consumer records

Party Identification: Required element ensuring clear identification of all parties involved in the records release

Records Description: Specific and detailed description of which records are to be released

Purpose Statement: Clear statement of the purpose for which the records are being released

Duration Specification: Explicit timeframe for which the authorization remains valid

Revocation Rights: Statement of the right to revoke the authorization and process for doing so

Re-disclosure Notice: Disclosure of potential re-disclosure of information once released

Signature Requirements: Specifications for required signatures, including format and validity

Authentication Requirements: Requirements for witness signatures or notarization if applicable

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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