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Authorization release information

Authorization release information 2026

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The document is an authorization form allowing a physician to release medical and hospital information to an attorney representing the patient in a personal injury claim. It requests the physician to provide all relevant medical records and prohibits disclosure of this information to anyone else without the patient's written consent.

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Click ‘Get Form’ to open the Authorization to Release Medical and Hospital Information in the editor.
In the first section, enter the name and address of your physician. This ensures that your attorney can obtain the necessary medical records.
Next, fill in the name of your attorney or law firm. This identifies who will be receiving your medical information.
Specify the name of the insurance company or defendant involved in your personal injury claim. This provides context for the release.
Review the authorization statement carefully. Ensure it clearly states that you authorize your physician to share all relevant information with your attorney.
Sign and date the form at the bottom. Your signature confirms that you agree to this release of information.

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