01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
Release record form 2026
Here's how it works
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out release record form with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
- Click ‘Get Form’ to open the release record form in the editor.
- Begin by filling out your personal information in the 'Patient Name', 'Maiden/AKA', and 'Date of Birth' fields. Ensure accuracy for proper identification.
- 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.
- If you are requesting records on behalf of another individual, complete the 'Other' section with their details, including name and address.
- Specify the purpose of the release in Section 4. Choose from options like 'Continuation of Care' or 'Attorney/Legal'.
- Indicate which records you wish to be released in Section 5. You can select specific packages or specify additional records as needed.
- Finally, sign and date the authorization at the bottom of the form to validate your request.
Start using our platform today to easily fill out your release record form for free!
See more release record form versions
We've got more versions of the release record form form. Select the right release record form version from the list and start editing it straight away!
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
Related links
(Name and address of facility/health care provider you wish to release information). To release information requested for (either DOB or SID is REQUIRED toRead more
Submit this form to request an amendment to your protected health information. Please be advised that the Release of Information team suggests that patientsRead more
If records are not readily reproducible by the agency in the format requested, courts have not required agencies to release the records in that format.Read more