What is a medical record release form? 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. Go to download medical records authorization form template for word. A medical records release form is a document that permits a medical office to disclose a patient’s protected health information.
