Medical Records Release Form - Waco Gastroenterology Associates 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. This information is crucial for identifying the correct medical records.
3. In the 'Release information from' section, specify the healthcare provider or facility releasing the records. Similarly, fill in the 'Release information to' section with the recipient's details, including address and fax number if applicable.
4. Select the purpose for which you are requesting this information by checking one or more boxes provided. If your reason is not listed, use the 'Other' field to explain.
5. Indicate which specific documents you wish to release by checking the appropriate boxes, such as office visit notes or lab results. For date-specific requests, fill in the relevant date ranges.
6. Review and check your consent regarding sensitive health information before signing. Ensure you understand your rights regarding revocation of this authorization.
7. Finally, sign and date the form at the bottom. If applicable, include your relationship to the patient if you are a legal representative.

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