A Medical Release of Information (ROI) Form is used to request that a health care provider release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both. There are several common reasons for a release of information, including for medical treatment purposes, medical billing, insurance billing, health studies, legal proceedings, and marketing purposes.

The Health Information Portability and Accountability Act (HIPAA) has rules in place to protect health information from being improperly used or disclosed. When someone requests access to your medical records, HIPAA requires that they obtain your consent. Using a Medical ROI Form helps prevent the release of medical records to unauthorized parties and helps keep your information confidential.

Medical Release of Information Form - English & Spanish