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REQUEST AND RELEASE OF MEDICAL …

    https://armypubs.army.mil/pub/eforms/DR_a/pdf/A4876.pdf
    Authorization Date (YYYYMMDD): DATE (YYYYMMDD) Relationship to Patient (If applicable) DATE (YYYYMMDD) APD LC v1.00ES Page 1 of 2. REQUEST AND …

AUTHORIZATION FOR RELEASE OF MILITARY …

    https://www.archives.gov/files/st-louis/military-personnel/public/na-13036-authorization-4-release-of-military-medical-patient-records.pdf
    The National Personnel Records Center, National Archives and Records Administration, is hereby authorized to release copies of my military medical treatment records as …

AUTHORIZATION TO RELEASE MEDICAL …

    https://www.publications.usace.army.mil/Portals/76/Publications/EngineerForms/ENG_FORM_6042-5.pdf
    Voluntary, however, failure to complete all appropriate portions of the form may lead to a delay in processing and / or denial of requests for reasonable accommodation on the …

AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR …

    https://www.redstone.amedd.army.mil/docs/pad/DD2870_RequestMedicalRecords_Form.pdf
    Failure to sign the authorization form will result in the non-release of the protected health information. This form will not be used for the authorization to disclose alcohol or drug …



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