I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. This post reviews what is required for a medical release authorization. What is a medical records release form. 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.
