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Example of a medical release form to write a medical release form. What is a medical release form.1 Write a document giving permission to a doctor or hospital to access your medical history and records created by another doctor or treatment facility. Doctors cannot access your medical history without your written consent.[1] 2 Type or print your date of birth, Social Security number, and maiden name if you have one.[2] 3 Write on a piece of paper, \”I authorize release of my medical records...

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