The official witnessing the oath should complete the date the sworn statement is taken, and then enters their signature, printed name and title. Physician-in-Training (PIT) Permit allows a qualified person to participate in a post graduate medical training or fellowship program.How do I fill this out? To fill out this form, gather necessary patient details including medical diagnoses and personal information. Please read this entire form before signing and complete all the sections that apply to your decisions relating to the disclosure. You can register a new supervising physician through the Online Supervisions and Prescriptive Delegation Registration System. This authorization form enables patients to release their medical records. It outlines the necessary fields required for proper disclosure. This article contains information on one way that certain nonparents can be allowed to consent to medical treatment of a minor child. Complete all required fields, sign, and then mail, fax or email the form along with a photo ID to one of the options below.