Back to Results
First PageMeta Content
Medicine / United States Department of Veterans Affairs / Government / Healthcare in the United States / Health Insurance Portability and Accountability Act / Social Security number / Veterans Health Administration / Social Security / Medical record / Health / Taxation in the United States / Medical informatics


OMB Number: Estimated Burden: 2 minutes REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL RECORDS OR HEALTH INFORMATION Privacy Act and Paperwork Reduction Act Information: The execution of this form does not au
Add to Reading List

Document Date: 2014-12-05 13:02:48

Open Document

File Size: 355,86 KB

Share Result on Facebook

Organization

Veterans Health Administration / SOCIAL SECURITY NUMBER NAME AND ADDRESS OF ORGANIZATION / VA Regional Office / Department of Veterans Affairs / Information Unit / /

ProvinceOrState

Virginia / /

SocialTag