Mecklenburg EMS Agency (MEDIC) - Authorization for Release of Health Information Form. Log in to your MyAtriumHealth account.This program offers a range of services to support family and informal caregivers to care for their loved ones at home for as long as possible. Mecklenburg County administers Medicaid for adults age 65 and over. If eligible, full coverage will pay for most medical needs. This form may be used to create a health care power of attorney, and meets the requirements of North Carolina law. Fill out the form below to request information, workshops, or answer questions related to aging in Mecklenburg County! The Division of Aging and Adult Services is responsible for planning, administering, coordinating and evaluating activities and programs for older adults. You usually can get a HIPAA authorization form from a doctor, hospital or other provider. There are eight documents you need to be making medical decisions for elderly parents.