Official Medical Records Release (HIPAA Compliant).

Fill out our secure digital wizard from your couch. Electronically sign your request, and we auto-route & securely E-Fax it directly to the hospital's HIM department, starting the 30-day legal clock. We integrate with the Federal NPI Registry and proprietary hospital directories to locate unpublished fax lines.

3-Minute Process NPI Registry Connected Fax Delivery Receipt

The Verified Routing Network™

Over 30% of medical records requests are delayed because patients accidentally fax them to the wrong hospital front desk. You don't have to guess. Our dispatch system is connected to the Federal NPI Registry and proprietary hospital directories. We boast a 95%+ success rate in locating the exact, unpublished Health Information Management (HIM) routing lines. If we can't find it, you get a full refund.

Select your request type to begin:

Stop fighting with hospital front desks.

Getting your medical records shouldn't require a fax machine you don't own. Why fax? Because hospitals routinely ignore emails due to HIPAA risks. By federal law, they must process secure faxes. We use their technology against them.

The Old Way (2+ Weeks)

  • 1. Download a confusing blank PDF form.
  • 2. Drive to a library or FedEx to print it.
  • 3. Sign it with a pen.
  • 4. Drive back to find a fax machine to send it.
  • 5. Call the hospital 5 times to ask if they got it.

The LawInMinutes Way (3 Min)

  • 1. Fill out our secure digital wizard from your couch.
  • 2. Electronically sign with a Federal ESIGN Audit Trail.
  • 3. We auto-route & securely E-Fax directly to the HIM dept.
  • 4. You receive an official Transmission Receipt. The 30-day legal clock starts instantly. Give them zero excuses.

Medical Records Release

Step 1 of 8: Patient Information

Secure 256-bit Connection

Patient Information

Healthcare facilities use these exact details to verify identity and pull the correct file from their database.

Representative Details

Note: You may be required by the facility to provide proof of guardianship or POA alongside this form.

Patient Details

The Releasing Facility

Who currently has the records? Provide the name of the hospital, clinic, or doctor.

Premium Feature

The Authorized Recipient

Tell the facility exactly who is authorized to receive these medical files.

Secondary Recipient (Optional)

Purpose of Request

Under 45 CFR §164.508, a valid HIPAA authorization must explicitly state the purpose.

Information to Disclose

Specify exactly what medical information the facility is allowed to release.

Exclude Sensitive Information

Select any information below that you explicitly want withheld (not sent) in this release.

Authorization Expiration

HIPAA requires this form to have an expiration date.

Delivery & Signature

Finalize your legal authorization so we can generate your document.

Enter your email address to securely receive your final copy. We never spam.

How would you like to sign?

Complete Request

Instantly generate your official release.

Concierge Fax Dispatch

Our dispatch team will query the Federal NPI Registry to locate the official Health Information Management (HIM) fax line for your facility.

  • Document generated instantly.
  • Dispatched within 1 business day.
  • You receive a transmission receipt email.

100% Refund Guarantee

If we cannot securely transmit your document to the verified HIM line within 1 business day, we will instantly refund your fee. No questions asked.

Certified HIM Dispatch

We will securely transmit your ESIGN-verified release directly to the fax number provided.

  • HIPAA 45 CFR §164.508 Compliant
  • Legal 30-Day Clock starts immediately
  • Fax Delivery Receipt sent in ~5 mins

You will receive:

SUCCESS: Transmission Receipt
Status: Delivered & Confirmed
Tracking ID: FX-849201A
Legal proof of delivery generated.

Document Generation

Your HIPAA-compliant request is perfectly formatted and ready.

  • Instant PDF Download
  • Ready to print and mail
  • Attorney-reviewed template
Total Due: $39.99

256-bit Encrypted Checkout

PREVIEW
Medical Records Release Request
AUTHORIZATION FOR THE RELEASE OF PROTECTED HEALTH INFORMATION
Section 1 - Patient Information
Patient Name:
DOB:
Address:
Phone:
Section 2 - Facility Authorized to Disclose Records
Facility / Doctor Name:
Address / Location:
Section 3 - Authorized Recipient
Deliver To (1):
Address / Fax (1):
Section 4 - Information to be Disclosed
General Records:
Dates of Treatment:
Section 5 - Purpose & Expiration
Purpose of Request:
Expiration Date: This authorization expires on .
Section 6 - Signature & Authorization
I authorize the use or disclosure of Protected Health Information as described above. I understand that I have the right to revoke this authorization at any time by providing written notice. I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditioned on whether I sign this authorization. I understand that if the person or entity that receives the information is not a healthcare provider or health plan covered by federal privacy regulations, the information described above may be redisclosed and no longer protected by these regulations.
Signature of Patient / Authorized Representative
Representative Name:
Relationship to Patient:
Date Signed

Certificate of Electronic Signature

Secure ESIGN Audit Trail

Document ID: Pending Generation...
Signer Name:
Timestamp: Will be stamped upon checkout
IP Address: Captured and securely logged.
Consent: ESIGN Act (15 U.S.C. § 7001) consent confirmed.
Medical Records Release Request
AUTHORIZATION FOR THE RELEASE OF PROTECTED HEALTH INFORMATION
Please complete all sections. If any sections are left blank, this form may be invalid.
Section 1 - Patient Information
Name:
DOB:
Address:
Phone:
Section 2 - Facility Authorized to Disclose PHI
Facility / Doctor Name:
Address / Location:
Section 3 - Recipient Authorized to Receive PHI
Deliver To (1):
Address / Fax (1):
Section 4 - Information to be Disclosed
General Records Authorized:
Dates of Treatment:
Section 5 - Purpose & Expiration
Purpose of Request:
Expiration Date: Unless revoked, this expires on .
Section 6 - Authorization Information
1\. I authorize the use or disclosure of Protected Health Information as described above.
2\. I understand that I have the right to revoke this authorization at any time by submitting a revocation in writing to the disclosing facility. Such revocation will not affect actions taken by the covered entity in prior reliance on this authorization.
3\. I understand that my treatment, payment, enrollment, or eligibility for health plan benefits will not be conditioned on whether I sign this authorization.
4\. I understand that if the recipient of this information is not a healthcare provider or health plan covered by federal privacy regulations (HIPAA), the disclosed information may be redisclosed and no longer protected by these federal regulations.
Signature of Patient / Authorized Representative
Date Signed