Records can be released to anyone authorized by the patient in writing. A valid authorization MUST contain the following information, or the request will be returned:

Patient’s full name and date of birth: List any other names the patient may have had.

Medical Registration Number (MRN): If available.

Specific information being requested: E.g., type of report/information and dates of service.

Purpose for which the information may be disclosed.

Recipient details: To whom the information is to be sent (name and address).

Authorization’s expiration date: If desired (see ROI form).

Signature: The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must include a copy of the guardianship papers or power of attorney.

Date of the signature.