These instructions will help you to complete the Authorization for Release of Health Information under the HIPAA (OCA960). The Authorization of Health Release Form enables family, friends, or others to obtain health information relating to individuals in custody.This service is available Monday through Friday from 8am to 4 pm EST. You must speak to the Medical Records Department and request a release of medical information authorization form from the hospital. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form. Montefiore Einstein is legally required to keep your medical records confidential. We can help you or an authorized party receive access when needed. Can't find your medical records in MyChart? Visit our site to submit a request for your records online using the Patient Medical Records Request Tool.