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Fax completed form to: (855) 292-9700. 1. â–· DON'T SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE. Signature.The signature of a minor patient is required for the release of some of these items. To give access to outside medical records, you will need to authorize release from your current health care provider(s). For federal tax information, contact the Internal Revenue Service (IRS). Under the Rule, a person authorized (under State or other applicable law, e.g. Fill out the Member Consent for Release of Protected Health Information (PDF). Authorizing release of tax information. Banner Health Information Management Services department is responsible for keeping complete medical records for each patient. The primary trustee must log in to Represent a Client and complete the primary trustee registration.