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

Document Attachments:

ERD-4972-E (Electronic Version - Word/59 KB)

ERD-4972 (Print Version - pdf/79 KB)

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