Release record form 2026

1. Click ‘Get Form’ to open the release record form in the editor.
2. Begin by filling out your personal information in the 'Patient Name', 'Maiden/AKA', and 'Date of Birth' fields. Ensure accuracy for a smooth processing experience.
3. Select your preferred delivery method for receiving your medical records. Options include electronic delivery via MyUofMHealth.org, US Mail, or pick-up from the ROI Unit.
4. If you are requesting records on behalf of someone else, complete the 'Other' section with the individual’s name and address, along with your relationship to them.
5. Specify the purpose of the release in Section 4. Choose from options like 'Continuation of Care' or 'Attorney/Legal'.
6. Indicate which records you wish to be released in Section 5. You can select specific packages or request additional records as needed.
7. Finally, sign and date the authorization at the bottom of the form before submitting it through our platform for processing.

Start using our platform today to easily fill out and submit your release record form for free!