• Request for Release of Patient Material

Complete Part A of the Request for Release of Patient Material and fax, along with your health care facilities Fax Cover Sheet to:

• Request for Release of Patient Material
• DD Form 2870 - Authorization for Disclosure of Medical or Dental Information

Complete Part A of the Request for Release of Patient Material and complete a DD Form 2870, Authorization for Disclosure of Medical or Dental Information or another HIPAA approved patient consent form. Fax forms, along with a Fax Cover Sheet to: Please note: Attorneys may submit a Court Subpoena in lieu of the DD Form 2870 or HIPAA approved patient consent form.