PMR 46 - Form 1: Authorization to Release Medical Information Form

Authorization to release records and information regarding an employee's medical and/or psychological ability to perform his or her duties with the County of Marin, to the County of Marin and/or its medical provider.

There are three ways to submit the form:

1. Submit electronically: Complete and submit the form online for County processing.
2. Print and submit a completed form: Click the “Preview PDF” button at the bottom of the form to print it and submit using an alternative method.
3. Print and complete by hand: Print a blank PDF version of the form, fill it out manually, and submit it using an alternative method.