I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form. These instructions will help you to complete the Authorization for Release of Health Information under the HIPAA (OCA960).The Authorization of Health Release Form enables family, friends, or others to obtain health information relating to individuals in custody. Patients or their representatives should complete and submit an Authorization to Release Protected Health Information (PHI) using this link. You must speak to the Medical Records Department and request a release of medical information authorization form from the hospital. Request and Share Your Medical Records. Alternatively, patients can complete the authorization form.