A medical records release form is a document that authorizes the release of patient health information from one healthcare provider to a. I hereby authorize the following health care professional, medical facility, mental health facility, laboratory, paramedical facility, medical examiner, medical records service, prescription. To request release of medical information please complete and sign this form i, ____________________________________hereby voluntarily authorize the disclosure of. 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. Go to download medical records authorization form template for word.