Medical Release Authorization
Document Number: ERD-4972-E
Description: This form is used to give permission for the Division to obtain medical information.
Comments: This authorization is to be used to assist in the investigation of a complaint filed with the Equal Rights Division of the Department of Workforce Development.
Content Contact: Equal Rights Information
ERD-4972-E (Electronic Version - Word/59 KB)
ERD-4972 (Print Version - pdf/79 KB)
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