Print, sign, and fax the form to the Medical Examiner's Office. Please review each form for directions and fax information.Examining Health Care Provider's Name. Phone: (______)______. This document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes. Here, learn about Texas' different types of powers of attorney, including general, limited, durable, springing, and medical powers of attorney. To fill out this form and submit via mail or fax, please download the Authorization to Disclose Health Information Form (PDF). Metro Health Epidemiology Division protects San Antonio and Bexar County residents and visitors from disease outbreaks.