Medical Records: Release Form & FAQsUCLA Health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Patient Information section. Ensure you print clearly and include the patient's full name, date of birth, address, and phone number.
3. In the Method of Release section, select how you would like the records sent. Options include paper, PDF, or verbal communication.
4. Specify the Purpose of Release by checking all applicable boxes. This helps clarify why you need the records.
5. Fill in the Release To section with the name and contact details of the person or organization receiving the records.
6. Indicate which specific Information to Release by selecting from provided options such as medical record abstracts or lab reports.
7. Complete any additional information requested at the bottom of the form before signing and dating it.

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