This form may be used to create a health care power of attorney, and meets the requirements of North Carolina law. North Carolina Department of Health and Human Services.This document allows your parents to appoint someone to make healthrelated choices on their behalf if they become incapacitated. 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. If you are 18 years old or older and are able to make and communicate health care decisions, you may use this form. This form has three parts. Complete the Authorization for Release of Health Information Form and identify the healthcare provider to whom you want your records sent. Consent to Release Medical Records. Download: Consent to Release Medical Records. Please call us at 704-667-9500 or toll-free at 844-383-2109 if you have questions or would like a blank form mailed to you.