Module 03 Content
OverviewReleasing medical records in medical facilities is something that happens each day. As healthcare professionals, it is important to understand and follow the proper protocol for releasing records. HIPAA is a set of guidelines used to guide medical professionals on how to maintain confidentiality for patient records. As a rule of thumb, medical records should be never be released without a medical release form being signed. Healthcare professionals must understand that medical records are legal documents and should be handled accordingly. Patients are able to have a copy of the medical records if they request it. However, patients, as well as medical practices, must understand that the proper legal procedures must be followed. Not handling the medical records according to legal procedures is a violation of HIPAA.ScenarioYou have just been hired at Rasmussen Healthcare Clinic. As part of your training, you are reviewing the clinic policy for the Release of Information. You recognize the current Release of Information document is incorrect and outdated. You bring this concern to your supervisor, and they ask you to create a new Release of Information form for clinic use.Instructions
Using a Microsoft word document or PDF, create and design a simple, generic medical release form that could be useful for a healthcare practice.
Some facilities have a letterhead with logos for documents in the facility. For this assignment, you can create a letterhead with just the name of the facility and the words “Medical Release Form” under the facility name. This should be in Bold using 18-pt font.
Your form must include the following information (be sure blanks are included for the information:

In a separate document, explain why this document is necessary and how it is legally being used in the medical facilities.

1st Section
Patient’s first and last name
Date of Birth
SSN
Full Address
Phone numbers (Home and Cell/Work)
2nd Section: This section can be titled “Information Requested From” and includes the information for the facility you work for. Note: this can be a prefilled section since it will be the standard document for your facility and should include the following information:
Name of Facility

Address of Facility
Office Phone
Office Fax

3rd Section: This section can be titled “Send Information To” and includes the information to whom you are sending the form to in order to obtain the records and should include the following:

Name of Facility
Address of facility
Office Phone
Office Fax
Section with check boxes (that need to be checked) that state how you want to receive the information: Send by Mail or Send by Fax
A list of items being requested so that the facility in which the records are being requested will know exactly what to send. Leading blanks should be included so that staff could mark an “X” next to what is being requested.
______ Entire Medical Record
______ Hospital Records
______ Lab Results
______ X-rays or MRIs