I hereby authorize the release of my medical information to the designated recipient. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. A medical records release form is a document that permits a medical office to disclose a patient’s protected health information. To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. Jotform’s medical records release authorization template allows you to quickly and easily gather signatures from patients or parents or guardians in order to release sensitive medical records.
