I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:. How do I fill out a HIPAA release form?Generally, a HIPAA-compliant authorization form is not necessary for most uses and disclosures that take place in the average medical practice. First, you would contact the healthcare provider that holds your records. Patient authorization is key to maintaining their right to medical information privacy. This post answers a few key questions about HIPAA authorizations. HIPAA regulations require that covered entities obtain a HIPAA medical release form (or medical records release authorization form) before PHI is disclosed. A valid Authorization to Release Medical Information form must be completed to receive copies of your ColumbiaDoctors medical records.