You have the right to see your own medical records and to authorize the release of your medical information to others. Use this form to:

• to get a copy of your own medical records
• to authorize release of records to someone else
• for peace of mind, before you or your loved ones need it

Before you purchase this form: Check with your health care provider to see if it has its own form for authorizing the release of medical records. If it does, your health care provider may prefer that you use that one. Use this form when your provider does not have its own, or when you want to provide a general authorization.

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