Please download the Authorization to Release Medical Information form, print and complete. The Authorization of Health Release Form enables family, friends, or others to obtain health information relating to individuals in custody.Authorization form is complete. Patients or their representatives should complete and submit an Authorization to Release Protected Health Information (PHI) using this link. Please download and complete the Request for Access to Health Information form and submit it to the facility where you were treated (select a location above). This authorization is voluntary. I understand that I can refuse to sign this authorization and the facility will not condition my treatment,. Alternatively, patients can complete the authorization form. By signing this authorization form, I am authorizing the use or disclosure of my protected health information as described above.