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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 complete blocks ...  Down

AUTHORIZATION FOR RELEASE OF INFORMATION -.pdf

AUTHORIZATION FOR RELEASE OF INFORMATION ... Branch of Military: ... Medical documentation dated/related to: Other ...  Down

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 ...   Down

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  • AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR …

    AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION ... This form is to provide the Military Treatment ... Health Plan to release the information ...

    www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2870.pdf
  • General Authorization For Release Of Information - …

    Personal Use Continued Medical Care School Other: ... AUTHORIZATION FOR RELEASE OF INFORMATION General Author: Humana Government Business

    www.humana-military.com/library/pdf/auth-release-general.pdf
  • REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL

    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
  • 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
  • INSTRUCTION AND INFORMATION SHEET FOR SF 180, …

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

    www.archives.gov/research/order/standard-form-180.pdf
  • AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR …

    ... This form is to provide the Military Treatment Facility/Dental ... RELEASE AUTHORIZATION ... REASON FOR REQUEST/USE OF MEDICAL INFORMATION

    www.wamc.amedd.army.mil/patients/deptservices/generalsurgery/bar...