Please fill out this form to authorize the release of your medical records. 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. Fax or mail the appropriate site listed on page 2 of the. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. This post reviews what is required for a medical release authorization.
