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This authorization is good until the date(s). Go to the Accounts Receivable website and select "FERPA Release Form.Specific instructions are also provided for completing the release of medical information form found in this booklet or on The Missouri Bar website. I,. , authorize and request the Missouri Department of Revenue, to release confidential tax records pertaining to for the tax reporting period(s): . I authorize MDMC to disclose the identified information to the persons and for the purpose described herein. The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. Specific instructions are also provided for completing the release of medical information form found in this booklet or on The Missouri Bar website. The Authorization to Release Information form gives us your permission to share or discuss your benefit information with someone else. Working on documents with our comprehensive and user-friendly PDF editor is easy.