Privacy and Confidentiality Release Form

Form Template

The Privacy and Confidentiality Release Form mobile app makes it easy to create an electronic medical release form using a smartphone or tablet.

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Once signed by the patient, the healthcare release form allows individuals to discuss your medical information and claims with other health care providers as well as insurance providers.

The medical authorization form is perfect for doctors' offices, hospitals and clinics who are required by law to protect patient health records. The helpful health information management and release form app tracks patient insurance information, treatments received and more.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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