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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
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Generally, only a patient can authorize the release of his or her own medical records. However, there are some exceptions to the rule and generally the following can sign a release: Parents of minor children. Legal guardian.
Processing the RequestReview the content. Staff should begin by verifying that requests for information contain all data required by internal policy and state and federal regulations.Verify the legal authority of the requestor .Verify the patient.Verify appropriateness of information requested for release .
Patient requests must be written without requiring a "formal" release form. Include signature, printed name, date, and records desired. Release a copy only, not the original. The physician may prepare a summary of the medical record, if acceptable to the patient.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.