Name: ________________________________________
Date: _________________________________________
Procedure 13-1:
Completing a Request to Release Medical Records
Objective: Obtain a signed patient authorization to release medical records to another person or
organization.
Equipment and Supplies: Electronic medical records release form and electronic signature pad;
or paper medical records release form and black pen; information about the specific records to be
released; name and address of the recipient; patient’s mailing address, if patient is not physically
present
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. Gather all supplies and
information. Log in to the EHR,
and access the medical records
request screen.
2. Verify the identity of the patient if
you have not already done so.
3. Confirm with the patient the
information requested, the
intended recipient, and the
recipient’s address.
4. Fill in the corresponding fields
on the form or screen for the
patient’s name, the information
requested, and the name and
address of the intended recipient.
5. Ask the patient to sign and date
the form in the designated place.
6. Visually verify the signature and
date to ensure the form was
completed correctly.
7. Inform the patient approximately
when the information will be
released, according to oce
policy.
8. If the patient is not present, print
out the form and highlight the
spaces to be completed. Place
the form and return instructions in
an envelope, apply postage, and
mail.
9. Save the screen in the EHR, and
confirm that the request is to
be sent to the medical records
department. If using a paper form,
route the completed form to the
medical records department.
POINT VALUE
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
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GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
10. Thank the patient, and ask if
there is anything else you can
assist with.
11. Close the patient’s electronic
health record.
12. Log o the system
GRADING
Points Earned
Points Possible 81 81
Percent Grade (Points Earned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
POINT VALUE
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
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click to sign
signature
click to edit
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