I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. The sample medical release form is available online that can be used to create one in word doc format. A medical records release form is a document that permits a medical office to disclose a patient’s protected health information. Please fill out this form to authorize the release of your medical records. What is a medical record release form?
