Medical Release Statement

A medical release statement refers to the particular type of statement which any and every medical authority issues right before they release a patient from their facility (either permanently or for a temporarily period). The statement is basically a brief report as to the medical condition of the patient, his or her treatment, the patient’s present condition etc.

The statement also records the supervising doctor, the name of the institution, the contact details and all other relevant information. For convenience of all the medical institutions or any individual who needs to frame a similar statement, being provided below is a sample of a medical release statement.

Sample Medical Release Statement

Name of the Medical Institution: Henry Forbes Memorial Hospital

Name of the Medical Examiner In charge: Dr. Mathew Dempsey

Date of release of the patient: 15th June, 2012.

Details of the Patient:

Name of the patient: Mr. Henry Williams III

Correspondence Address: 89, Hilton Apartments, Manhattan, New York, USA.

Contact No.: 354-873-545

Age: 35 years

Blood Group: O negative

Weight: 80 kilograms

Height: 181 cms

Initial Medical Condition:

Mr. Williams was admitted to the facility on the 14th of June, 2012. The patient had suffered deep tissue damage in his tail bone due to extensive exercise regime. The doctor assigned provided the required treatment.

Medical Release Statement:

The patient is being release after 24 hrs of observation. The doctor in charge of Mr. William’s has agreed to the release him on his agreement to follow all the recommendations/ treatments. The patient has been recommended to be at bed rest for the next week along with some physiotherapeutic treatment on regular basis. The patient is required to take the medicines as per the prescription provided and also come back for a check- up a week from the date of release. He is advised to keep away from the exercising.