Templates · Free template · Privacy
Release of Information (Records Release) Form Template
A printable release of information form that lets a clinic send or receive a patient's records with their written permission, naming who, what, why, and for how long.
Specific beats general
A release should say who is authorised to share information, who will receive it, exactly what will be shared, and for what purpose. Vague blanket releases are the ones that get challenged.
State when the release expires and that the patient can withdraw it. Health privacy rules differ by province, so check yours and have the wording reviewed.
Release of Information (Records Release) Form
Patient
Release
Acknowledgements
Signatures
Template from zdrovia.ca/templates/release-of-information-form/ · Review with your medical director, regulatory college guidance, and insurer before use.
Send this form before the appointment instead of printing it
Zdrovia's form builder turns this template into a digital form your clients sign on their own phone. The signed copy files into their chart with the exact version they saw, and photo consent stays separate from treatment consent. It's free for solo practitioners, with data stored in Canada.
See how Zdrovia is set up for group practices.
Frequently asked questions
How long should a release be valid?
Set an expiry, commonly six to twelve months or the length of the care episode.
Is written consent always needed to share records?
Not always, since privacy law allows some sharing for care. When in doubt, ask for written consent.
Related
This template is a starting point for discussion with your team and advisors, not legal or medical advice. Requirements vary by province and profession. Have your medical director, your regulatory college's guidance, and your malpractice insurer confirm the wording before you use it with patients.