Authorization to Release Health Records and Information
San Mateo Superior Court · Adoption
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Last updated July 19, 2026
This form allows a person to give permission for their doctor, hospital, or other healthcare provider to share their medical records and health information with a specific person or organization. Someone would need this form if they want their healthcare provider to release their records to a lawyer, insurance company, family member, or another party who doesn't normally have access to that information.
This form must be printed and filled by hand, or opened in Adobe Acrobat.