To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. 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. Completed and signed forms can be submitted the following ways: The sample medical release form is available online that can be used to create one in word doc format. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription.
