Hospital Release Form

July 9, 2011

A hospital release form terminates the legal liability that exists between the hospital and patient. Releases are used to protect the hospital from any possible liability regarding the patient’s health as a result of medical procedures undertaken.  The release is routinely issued as a legal requirement. The hospital release form specifies the terms of agreement.

Sample Hospital Release Form

I………………….. (Name of patient) hereby release ……………………. (Name of hospital)……………………..from liability following my treatment at…………………… (Name of hospital) as per the terms of this release agreement. The period of treatment run from…………………… (Date) to……………………. (date). I hereby release all liability from the physicians and other staff members of the hospital for any arising medical condition presently or in the future. I hereby release anyone operating or functioning under the employment of this hospital from any liability regarding my health by virtue of any side effects or future medical complaint.

I have read and understood this hospital release form.

Name of Patient……………………………………

Date …………………………………………………..

Patient’s signature……………………………………

Hospital Stamp……………………………………..

 

Download Hospital Release Form in Word Format

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