I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. Go to download medical records authorization form template for word. A medical records release form is a document that authorizes the release of patient health information from one healthcare provider to a. To get your medical history or to do it on behalf of the person who authorized you to get it through a medical release form, you have to take several steps. To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of.
