Skip main navigation

Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.

  2. Forms Repository
  3. ERD-4972-E, Medical Release Authorization

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/50 KB)

ERD-4972 (Print Version - pdf/49 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

Having trouble finding the correct form? Forms Contacts