Individuals that request the disclosure of their protected health information are urged to use the following authorization form that meets HIPAA requirements. Please return the DHS-390, Adult Services Application, and DHS-54A, Medical Needs Form, to the MDHHS office in the county where the client lives.The witnesses must be 18 or older. This form is used to advise Medicare of the person or persons you have chosen to have access to your personal health information. Direct free access to PDF of HIPAA release. Free immediate download of medical relasese form PDF. Organizing financial documents and medical records can help you understand your loved ones eligibility for public health insurance or VA benefits. An individual age 18 or older and who has sufficient mental capacity may make a Will. 2. There are several kinds of wills. This form is for non-contracted providers.