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Fill out the form completely. The authorization is not valid unless it is filled out completely.The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. Complete only if eDelivery is requested. Authorization to Release Information. This form is used to advise Medicare of the person or persons you have chosen to have access to your personal health information. Purpose of Authorization and Release. Keep a copy of this completed form for your personal records. Authorization to Release Personal. Information. These instructions will help you to complete the Authorization for Release of Health Information under the HIPAA (OCA960).