Get Ny Cs Ehs-742 6/06 2006-2026

Filling out the NY CS EHS-742 6/06 form is an essential step in authorizing the release of your medical information. This guide will walk you through each section of the form to ensure that you complete it accurately and effectively.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your personal information in the designated fields, including your last name, first name, middle initial, date of birth, street address, city, state, and zip code. Ensure that all information is printed clearly.
3. Provide your social security number in the corresponding field. This information is required for processing your request.
4. In the authorization section, write your name clearly on the line provided to indicate that you are giving permission for the release of your medical records.
5. Specify the records you are authorizing to be released, including EHS nurse records, EHS medical records, and personal physician's records. Be thorough in indicating the relevant dates and conditions associated with these records.
6. Indicate the purpose for which the records will be used by selecting one of the options, such as 'my personal use' or 'by EHS to determine your ability to perform the duties of your position.'
7. Sign and date the form in the designated area at the bottom to validate your authorization.
8. Review your completed form for accuracy and clarity before finalizing.
9. Once the form is filled out and confirmed, you can save your changes, download a copy, print it, or share it as necessary.

Complete your NY CS EHS-742 6/06 form online today and take the first step in managing your medical information.