A sample hospital release form can help people come up with a hospital release form that serves as an agreement between the hospital and the patient. The agreement seeks to release the hospital and anyone associated with it from liability after the patient has received treatment. It is overseen by a lawyer and the agreement is binding.
Sample Hospital Release Form
I……………………………………………. (Patient’s name)……………………………hereby release……………………………. (Hospital’s name)…………………………from liability as pertains to the medical treatment that I have received from this hospital from…………………. (Date when treatment commenced)………………………….to……………………. (Date when treatment ended)……………………………….. I further release the doctors, medical personnel, care givers and all other staff members associated with the hospital’s activities from all liability regarding my heath from this day forth in relation to the treatment and all medical procedures undertaken during the period of medical care.
The information provided in this release form is to the best of knowledge and I am of sound mind to execute it.
Patient’s Name…………………………………………
Patient’s Signature……………………………………..
Date………………………………………………………….
