Completed and signed forms can be submitted the following ways: A medical records release authorization form is a document that allows healthcare providers to share a patient's medical records with specified parties, such as insurance companies or other. This medical records authorization form template for word is a written permission saying you. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. Fax or mail the appropriate site listed on page 2 of the.