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The document is a Records Release Authorization form allowing Neurology Associates/Pearl Barlow Center at NYU Langone Medical Center to release a patient's complete medical history and treatment records to specified programs, including the Clinical Trials Program and NYU Alzheimer’s Disease Center. It includes sections for the patient's name, address, date, signature, and witness.

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Click ‘Get Form’ to open the Barlow Center Records Release Authorization in the editor.
Begin by selecting the programs you wish to authorize for record release by checking the appropriate boxes next to 'Clinical Trials Program' and/or 'NYU Alzheimer’s Disease Center'.
Fill in your complete medical history records request by specifying the period of treatment in the designated fields labeled 'from' and 'to'.
Enter your name and address in the provided fields to ensure proper identification.
Date the form by entering today’s date in the specified field.
Sign the document in the signature field. If you are signing on behalf of someone else, please indicate your relationship.
Lastly, have a witness sign in the designated area to validate your authorization.

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For more information about memory and aging NIA Alzheimers and related Dementias Education and Referral (ADEAR) Center. 800-438-4380. adear@nia.nih.gov. National Institute of Mental Health. 866-615-6464. nimhinfo@nih.gov. Eldercare Locator. 800-677-1116. McKnight Brain Research Foundation. 407-237-4485.

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Neurological exam These tests can help look for conditions that affect memory and other mental abilities, such as Parkinsons disease, strokes and tumors. The neurological exam may test: Reflexes. Eye movements.