To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. Completed and signed forms can be submitted the following ways: I hereby authorize the release of my medical information to the designated recipient. This medical records authorization form template for word is a written permission saying you.
