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Record release form 2026
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- Click ‘Get Form’ to open the record release form in the editor.
- In Section I, print the name of the applicant or member who is requesting the medical information.
- Proceed to Section II and enter the name, address, and telephone number of the health-care provider authorized to share medical information.
- In Section III, specify what medical information can be shared. Check any boxes if you wish to restrict sharing of sensitive information like AIDS/HIV status or drug/alcohol use.
- Sign and date the form in Section V. Ensure that all signatures are original and written in ink. If applicable, a parent or legal guardian must sign for minors.
- Review all sections for completeness before submitting. Remember, leaving any section blank may invalidate your request.
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Related links
To receive copies of your Weill Cornell Medicine medical records please complete an online Release of Information (ROI) Authorization form, which will be sentRead more
If records are not readily reproducible by the agency in the format requested, courts have not required agencies to release the records in that format.Read more