Click below to get started. How to Request a Medical Record.To request your record, please complete the following form: Authorization to Disclose Confidential Information Form. Requests for medical records for yourself or a patient under your care must be submitted on our Authorization to Release and Obtain Health Information form. Enter your scheduled Medical Exam's Date and Time in the fields at the top of this form. 3. Scan and save the completed and signed form. For EMS requests, call the Records Custodian at 954-828-6800. The form below is only for EMS medical records, transport records and general information.