Get Wi Dhs Authorization Disclose Form 2014-2022
ADDD WHOSE Records to be Disclosed First Middle Name SSN Last Birthday mm/dd/yyyy AUTHORIZATION TO DISCLOSE INFORMATI ON Disability Determination Bureau DDB P L EA S E R E AD T H E E N TI R E FO RM B O TH P A G E S B EF O R E S I GN I N G B E LO W I voluntarily authorize and request disclosure including paper oral or electronic interchange OF WHAT All my medical records also education records and other information related to my ability to perform.
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