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Get EFMPAuthorizationFor DisclosureProtectedHealth. Authorization For Disclosure Of Protected Health

Th the Privacy Act of 1974 (Public Law 93-579), the notice informs you of the purpose of this form and how it will be used. Please read it carefully. AUTHORITY: Public Law 104-191; E.O. 9397 (SSAN); 42 CFR Part 2; 45 CFR 164.528. PRINCIPAL PURPOSE(S): This form is to provide the Coast Guard Clinic with a means to request the use and/or disclosure of an individual s protected health information to appropriate military authorities for evaluation of fitness for initial and continued partici.

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