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Get SSA-827 2005

O DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) SSN ** PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW ** I voluntarily authorize and request disclosure (including paper, oral, and electronic interchange): All my medical records; also education records and other information related to my ability to OF WHAT perform tasks. This includes specific permission to release: 1. All records and other information regarding my treatment, hospitalization, and outpatient care.

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