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. Medical release forms include details about. Fax or mail the appropriate site listed on page 2 of the. A medical records release authorization form is a document that allows healthcare providers to share a patient's medical records with specified parties, such as insurance companies or other.
