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AUTHORIZATION FOR RELEASE OF MILITARY MEDICAL.pdf

OMB No. 3095-0039 Expires 07/31/2014 AUTHORIZATION FOR RELEASE OF MILITARY MEDICAL PATIENT RECORDS NOTE: Records Center personnel ...  

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR.pdf

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION ... the Military Treatment Facility ... TRICARE Health Plan to release the information ...  

result in the non-release of the protected health.pdf

REASON FOR REQUEST/USE OF MEDICAL INFORMATION ... The Military Health ... provider/treatment facilitylTRICARE Health Plan to release the information described ...   Down

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  • result in the non-release of the protected health

    REASON FOR REQUEST/USE OF MEDICAL INFORMATION ... The Military Health ... provider/treatment facilitylTRICARE Health Plan to release the information described ...

    www.med.navy.mil/sites/nmcsd/Documents/DD2870.pdf
  • AUTHORIZATION FOR RELEASE OF INFORMATION

    Branch of Military: ... To release to: ... (Retirement History) Medical documentation dated/related to: Other: (Specify) ...

    www.ndguard.ngb.army.mil/contact/Documents/Release-Of-Information.pdf
  • REQUEST FOR AND AUTHORIZATION TO RELEASE …

    REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL RECORDS OR HEALTH INFORMATION. ... Release of Information Unit at the facility housing ... “Patient Medical ...

    www.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf
  • Military Information Release - New York City

    Military Information Release I, ... or hardcopies from my military personnel and related medical records, or any information outlined below on the left hand corner.

    www.nyc.gov/.../Military Information Release Employment_09.pdf