No information is available for this page. A healthcare professional must complete a certification for you about your medical condition and need for services.This form is an authorization that will permit your healthcare providers to release your health information to your designated adult proxy. A Caregiver's Authorization Affidavit is an official form based on California's recognition that adults who have minors living with them are "caregivers." SW. Obtain declaration from physician (usually PCC doctor) on why medical treatment is necessary on the 04-44 form. Our Release of Information (ROI) Department helps you complete forms for disability or medical leave and provides required medical information.