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The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. Providing individuals with easy access to their health information empowers them to be more in control of decisions regarding their health and well-being.The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. This form is used to advise Medicare of the person or persons you have chosen to have access to your personal health information. Note: A single Authorization form may not be used to authorize the release of Psychotherapy Notes and other medical records. Note: A single Authorization form may not be used to authorize the release of Psychotherapy Notes and other medical records. To obtain your medical records, you will need to complete an Authorization for Release of Protected Health Information Form (Spanish, Polish). A patient's medical records can only be accessed or released with proper authorization from the patient or the patient's legal representative. AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION, Client Name. Michigan Department of Health and Human Services.