A release form is your written consent for Circle Medical to send your records to someone else, such as another doctor, a pharmacy that is not on your profile, or a clinic taking over your care.
This article explains when you need the form, what to put on it, how long sending usually takes, and what to do if the other office does not receive the fax.
Looking for something else? This article is about Circle Medical sending your records out.
A copy for you only: How to get your own medical records.
Records from another clinic coming to Circle Medical: How to share medical records with your Circle Medical provider.
A form or letter your provider fills out, such as FMLA or a diagnosis letter: How to submit a form for your provider to complete. That is not a records release.
When you need a release form
You are transferring your care from Circle Medical to an outside provider.
You need records sent to a pharmacy that is not saved on your profile.
Someone requested your records and you have not signed that request.
The form is where you say who may receive the records, and whether they get the whole chart or only the parts you name.
How long does a release take?
You get a confirmation email when the form is submitted. No published article states how many days the fax takes after that.
You get the form: after you start a chat and we have the recipient's details, we email the form for you to sign.
You submit the form: you get a confirmation email that the form was submitted.
We send the records: after you tell the support team the form is signed to release the records, we fax the form and the records you selected. The form and records are typically faxed within 3 business days. You will be notified by chat when the fax is sent.
Step 1: Tell us where to send the records
Start a chat with the support team. Select Medical Records and the option to transfer records to another entity. Include:
Full name of the provider who should receive the records
Facility name and full address
Phone number and fax number
Which records to send, or say that you want the whole chart
We email you a release form to sign with Dropbox Sign.
The release form link is active for 14 days.
Some fields may already show your name, date of birth, the recipient, and the records, when we have them.
Step 2: Sign the release form
Three checkboxes
Consent to release. Check the box that authorizes Circle Medical to disclose the protected health information (PHI) listed on the form to the location on the form.
All records. Check the box for all protected health information if you want the whole set sent. The form describes that set as provider notes, medication lists, discharge summaries, emergency department records, procedure and operative reports, immunization records, and radiology records.
Specific records. Check this instead of all records if you want to name what is sent.
Three initials, when those records are included
If you checked all records or specific records, and the chart includes the category below, initial that line to release it. Leave it blank to keep it out.
Mental health or developmental disability treatment records, excluding psychotherapy notes
Substance abuse disorder treatment, facility, or program notes
HIV infection status
Two required text fields
Your full name
Your signature
Then select Next, Continue, and I agree. You get a confirmation email that the form was submitted.
This medical record release is valid for one year.
Step 3: Tell us you signed
After you submit the form, reply in the chat you already opened, and say the form is signed. We then fax the form and the records you selected to the recipient on the form. The form and records are typically faxed within 3 business days.
Step 4: We send the records
We fax the signed form and the records you authorized. Signing the form is the consent we need to send them to that recipient.
You will get a confirmation message in your chat once the records have been sent.
A copy for you and a copy for the other provider
Ask for both in the same chat. Say you want a copy for yourself and a copy sent to the other provider. Give the recipient details above, and sign the release form for the copy that goes to them.
When to contact the support team
No Dropbox Sign email after you sent the recipient's details: start a chat. Check spam first.
You signed and have not been told the records were sent within 3 days: start a chat. Include the facility name and the date you signed.
The other office says they do not have the fax: start a chat. Include their name, address, phone, fax, and what they told you.
You need a different recipient or a different set of records: start a chat before we fax. A new recipient needs your authorization on the form.
What to do if something goes wrong
I have not received the release form
Check the email on your Circle Medical account, including spam. If it is not there, start a chat and ask us to resend the Dropbox Sign email. Do not send your chart to the other office yourself from a download link.
I signed and nothing has been sent
The fax does not start until we know the form is signed. If you already told us, start a chat with the date you signed and the facility name.
The other office never received my records
Start a chat. Include the provider name, facility name, address, phone, and fax, plus the date you signed. We can check the fax number and resend. Do not give them your personal download link.
I only wanted a copy for myself
You do not need this form for that. Use How to get your own medical records.
Not a release to another provider?
A copy for you: How to get your own medical records.
Outside records coming to us: How to share medical records with your Circle Medical provider.
Forms and letters: How to submit a form for your provider to complete.