By signing this authorization form, I am authorizing the use or disclosure of my protected health information as described above. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:.This joint notice describes how medical information about you may be used and disclosed and how you can get access to this information. The Authorization of Health Release Form enables family, friends, or others to obtain health information relating to individuals in custody. Please follow the instructions below and complete the Authorization to Release Medical Records Form to help us process your request. Find forms that school staff and Family Welcome Centers provide to families for enrollment, registration, and more.