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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 ... This form is to provide the Military Treatment ... Health Plan to release the information ...  

AUTHORIZATION FOR RELEASE OF INFORMATION.pdf

Branch of Military: ... (Retirement History) Medical documentation dated/related to: ... A photocopy of this release is as effective as the original ...   Down

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  • AUTHORIZATION FOR RELEASE OF INFORMATION

    Branch of Military: ... (Retirement History) Medical documentation dated/related to: ... A photocopy of this release is as effective as the original.

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

    REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL ... Release of Information Unit at the facility housing the records.€ Redisclosure of my medical

    www.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf
  • 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
  • Standard Form 180: Request Pertaining to Military Records

    The Standard Form 180, Request Pertaining to Military Records ... Release of information: ... All Documents in Official Military Personnel File (OMPF) Medical

    www.archives.gov/research/order/standard-form-180.pdf