The Authorization of Health Release Form enables family, friends, or others to obtain health information relating to individuals in custody. 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).Complete this form now or at any time if you want to give or deny your providers access to your records. You can request, download, and access your medical record right to your smart phone or computer, through NYU Langone Health MyChart, our secure patient portal. Download, print out, and fill in our forms in advance of your first visit. All forms are in the PDF format. To receive a copy of your medical record, print out and complete our authorization form.