AUTHORIZATION TO RELEASE HEALTH RECORDS 2026

1. Click ‘Get Form’ to open the AUTHORIZATION TO RELEASE HEALTH RECORDS in our editor.
2. Begin by entering the client's full legal name and any previous names in the designated fields. Ensure accuracy for proper identification.
3. Fill in the current address and, if applicable, check the box to update any previous addresses. Include the date of birth and phone number for contact purposes.
4. In the 'Information Released FROM' section, select the relevant Wyoming Department of Health divisions or programs that will release your health information.
5. For 'Information Disclosed TO', enter the name and complete address of the individual or organization receiving the information. If it's for yourself, select 'self'.
6. Choose your preferred delivery method: fax, mail, email, or pick up by client/designee. Provide necessary details based on your selection.
7. Specify which records you want released and state the purpose of disclosure from the provided options.
8. Review all entered information for accuracy before signing. Remember that this authorization expires one year from the date signed unless specified otherwise.

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