Authorization Forms and Instructions
Download and complete the following forms to obtain the information you seek. Directions on how to submit are included in each form.
Request Your Medical Records
- Duke Health Enterprise Authorization for Release of Protected Health Information form English (PDF, 800 KB) and Spanish (PDF, 667 KB)
- View the instructions for completing the authorization form (PDF, 594 KB)
Request Proxy Access
- Authorization for Adult Proxy Access to My Duke Health form in English (PDF 439 KB) and Spanish (PDF 482 KB).
Permit Verbal Information Be Given to a Friend or Family Member. This may be useful when someone is scheduling an appointment on your behalf.
- Duke Health Enterprise Verbal Release of Information Authorization English (PDF, 516 KB) and Spanish (PDF, 214 KB)
Grant Access to Your Medical Record to a Provider not Directly Involved in Your Care
- Duke Health Enterprise General Authorization to DHE Providers' Access to Individual Electronic Medical Record (Maestro Care) (PDF, 766 KB)
Grant Access to Medical Record to a Duke Health Provider who is a Parent or Legal Guardian of the Patient (Age 12 - 17)
- Duke Health Enterprise Minor Patients (12-17 Years) Authorization to DHE Providers' Access to Individual Electronic Medical Record (Maestro Care) (PDF, 670.37 KB)
Request for non-Duke Health Records to Be Sent to Duke Health
Your Duke Health provider may need to request health records from a non-Duke Health entity that cannot be accessed through a healthcare information exchange.
- Duke Health Enterprise Request for External Records form in English (PDF, 298 KB) and Spanish (PDF, 303 KB)
Request a Deceased Patient's Medical Records if You Are the Surviving Spouse or Next of Kin
- Duke University Health System Affidavit of Surviving Spouse or Next of Kin (PDF, 82.04 KB)
Accounting of Disclosures Request
- Duke University Health System Request for an Accounting of Disclosures Form (PDF, 197 KB)
Interpreter Services
Duke Health offers a range of free language assistance services for all patients who prefer to communicate in a language other than English. Learn more about the interpreter services available at Duke Health.