Authorization For Release of Medical Records 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of your child or children in the designated field. Ensure that you provide accurate names for proper identification.
3. Next, fill in the date of birth for each child listed. This is crucial for verifying medical records.
4. In the section labeled 'Name of Mother', input your full name along with your date of birth to confirm your identity as the authorizing parent or guardian.
5. Review the authorization statement carefully. If you agree, proceed to sign in the designated area, confirming your relationship to the child or children.
6. Finally, if you wish to receive a copy of the records, remember to include a self-addressed manila envelope as instructed.

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