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  • Open Records Request Form 4.13.11

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Ty State Zip Requesting releasable information through the Open Records Act for the following facility: Facility Name Address City State Zip Date Range of Documents requested to . The Office of Inspector General (OIG) is able to release the following information. Mark any and all that apply: Statement of Deficiencies / Plan of Correction Type A or B Citations License Other: Format of documents requested, choose one: CD $10.

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The attached DD Form 2870, Authorization for Disclosure of Medical or Dental Information, authorizes Fox Army Health Center (FACH) to release medical information to specific individuals other than the patient for purposes other than treatment, payment or healthcare operations. Block 5: Mark all that apply.

DD Form 877-1 is the only request form which NPRC will accept from military facilities for retired medical treatment records.

Texas Government Code, Chapter 552, gives you the right to access government records; and an officer for public information and the officer's agent may not ask why you want them.

To request clinical and medical treatment records: Mail a letter or National Archives (NA) Form 13042, Request for Information Needed to Locate Medical Records, to: National Personnel Records Center. 1 Archives Drive. St. Louis, MO 63138. Fax a letter or NA Form 13042 to: 314-801-9195.

The Freedom of Information Act (FOIA) and similar open records acts allow the public access to records under the control of governmental agencies. These access rights state that public information shall be delivered within a very strict time frame.

Medical records request form is a document that is used to request for the medical records of a patient from a healthcare provider. This form includes the details of the specific medical records that are being requested along with the personal details of the patient such as their name and date of birth.

Use GSA Form SF180 to request your military service records, like your DD214 or other separation documents, your orders and endorsements, and your military medical records.

Failure to request an Attorney General opinion and notify the requestor within 10 business days will result in a presumption that the information is open unless there is a compelling reason to withhold it.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232