Record Release

To receive a free copy of any MedMemory health tracking or medical form, send an email to sales@medmemory.com or call us toll free at 1-888-633-6679!

To receive all 15 health tracking and medical forms on your MedMemory Health Information Manager

Order your Pill Box, Key Chain, USB Drive Today!

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Order your Value Model USB Today!

The MedMemory Health Information Manager is a Personal Health Record that allows the user to store medical records and other key information on a medical alert designed flash drive. The MedMemory PHR is the future of Medical ID Bracelet and must have for PERS users. Some examples of the templates included with the MedMemory program include Medical Records Release, Power of Attorney, Living Will, Emergency Contacts Form, Advance Directives Form, Allergy Log, Immunization Log, Diabetes Log, Insurance Forms and Providers Template. The Medmemory PHR is a Medic Alert that is a great managemet tool for Caregivers and Business Travlers!

Record Release

The Record Release Form is a template form that you can use to request your medical records or other information be released to third parties. The Record Release can be used as a document for information requests or substituted for forms  such as: medical release, medical release forms, form release, release forms, information release and authorization release.

How To Use The Record Release Form

In addition to the exceptionally user friendly MedMemory program, a MedMemory flash drive purchase includes free Health, Medical, Emergency Contact and Lifestyle templates. All MedMemory templates are designed so that the user only has to use tab key to navigate the template to enter important information.  The object of Release Form is to provide the user an easy to use option to attach to the MedMemory program or print out in an emergency or provide at a healthcare visit.

Record Release Form Data Fields

• Name / DOB
• Date Of Declaration
• Designate Organization That Can Make Disclosures
• Specify The Type Of Information To Be Released
• Designate Organizations That Information Can Be Made Available To.
• Specify The Purpose Of The Information Release
• Set Expiration Date For The Release Of  Information

To receive a free copy of any MedMemory health tracking or medical form, send an email to sales@medmemory.com or call us toll free at 1-888-633-6679

To receive all 15 health tracking and medical forms on your MedMemory Health Information Manager

Order your Pill Box, Key Chain, USB Drive Today!

Order your Credit Card USB Today!

Order your Value Model USB Today!