Form C-101 (BWC-1224) Authorization to Release Medical Information - Ohio
Authorization to Release Medical Records
Authorization to Release Information
Authorization for Medical Treatment, and Waiver and Release of Claims, for Minor Participant of: Civil Air Patrol National Cadet Competition
Medical Records Request and Authorization to Use and Disclose Protected Health Information (Phi) Form - City of Cleveland, Ohio
FS Form 13 Authorization for Release of Information
FS Form 14 Authorization for Release of Information
Form CM-936 Authorization for Release of Medical Information (Black Lung Benefits)
Form HEA7183 Release of Information and Consent - Children With Medical Handicaps Program - Ohio
DA Form 5459 Authorization to Release Information From Army Records on Nonsupport/Child Custody/Parentage Inquiries
VA Form 0710 Authorization for Release of Information Protected Under the Fair Credit Reporting Act (Title 15, Section 1681)
Form RD3550-1 Authorization to Release Information
GSA Form 3590 Authorization for Release of Information
Form ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio
VA Form 0857K Authorization for Limited Release of Medical Information
Form CMS-10106 Authorization to Disclose Personal Health Information Release Form
NOAA Form 56-67 Authorization for Release of Medical Records (From CPC)
Notification and Authorization to Release Criminal Information for Entry
Form SHR-MD-67 Fcso Medical Release of Information Form - Franklin County, Ohio
Formulario CMS-10106 Formulario De Autorizacion Para Divulgar Informacion Medica Personal (Spanish)
Permission Template to Release Medical Treatment Facility Records
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