For a patient’s medical records to be released from this facility, the patient must contact the Orthopaedic and Sports Medicine Center’s Medical Records Department for a separate Authorization to Release Medical Information.

Permission to Share Your Orthopaedic and Sports Medicine Center Medical Information
Digital Signature
I attest that the above information is correct and to the best of my knowledge. I have read and understand the entire contents of the form and have had the opportunity to ask questions regarding the information of this form.