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