Prepare a Release of Damages Claim Against Hospital with this template form for the United States. The release should be obtained from the patient upon payment of an agreed settlement amount from the hospital.

The patient releases the hospital from its present claim and from future claims for damages, costs, expenses or compensation arising from or with respect to treatment the patient received from the hospital. The release evidences full and complete settlement of the claim, and is intended to avoid litigation.

This USA hospital claim release form is provided in MS Word format, and is fully editable to fit your particular circumstances.