Release of Information form here - Boca Raton Regional Hospital 2026

1. Click ‘Get Form’ to open the Release of Information form in our editor.
2. Begin by entering the Patient Name and Date of Birth (DOB) in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the last four digits of the Social Security Number and Medical Record Number (MR#) if applicable. This helps streamline your request.
4. Indicate your authorization for releasing sensitive medical information by checking the appropriate boxes. Specify any additional records you wish to include.
5. Select your preferred format for receiving the records: Paper Records or CD, ensuring convenience in how you receive your information.
6. Clearly state the purpose for which you are requesting this information and list any specific dates of service relevant to your request.
7. Review all entered information for accuracy before signing. Your signature confirms your authorization and understanding of the terms outlined in the form.

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