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You can use one of our free printable templates (pdf & word) to authorize the release of medical records. Web medical records release form sample. This medical records request document is used by a patient to request that a healthcare provider who has treated them release their medical records to a specific. Web choosing the best type of hipaa form is important to authorize an individual, medical professional, billing office, or insurance representative to release or view medical records. Web to request release of medical information please complete and sign this form i, _____hereby voluntarily authorize the disclosure of information from my health record. Web medical records release authorization form (waiver) | hipaa. The medical record information release (hipaa) form allows patients to give authorization to a.