Qualified Health Care Provider,

If you require an Authorization for Release of Medical Information in order to provide information about the illness or injury that your patient is applying for benefits for, the Authorization will be mailed to your patient. The patient is instructed to sign the Authorization and deliver it to his/her healthcare provider. The Statement of Attending Physician is mailed directly to the healthcare provider and is to be returned to TDI. For your convenience, you may download additional copies of the Authorization for Release of Medical Information here.

Medical Release Form (in pdf)