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No information is available for this page. Note: All applicable fields must be completed for this form to be considered valid.Request Medical Records. B. Date of Rehire (if applicable). Please read this form carefully. ❒Office of Maine Care Services. PhotoVideo Release Form 2011.doc. After this form has been completed and signed, the Navigator will send the original to the Homeless Initiatives Program Officer. 3. Pursuant to 25 MRSA §2003 (1)(E)(1), I authorize the Riverview Psychiatric Center and the Dorothea Dix Psychiatric. Authorization for Release of Information.