To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. A medical records release form is a document that permits a medical office to disclose a patient’s protected health information. Medical release forms include details about. 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.
