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Get USPS PS 2488 1987-2024

In addition this information may be PS Form 2488 June 1987 disclosed to an appropriate law enforcement agency for investigative or prosecutorial purposes to a congressional office at your request or where pertinent in a legal proceeding to which the Postal Service is a party to OMB for review or private relief regulation to a labor organization as required by the NLRA or to an agency where relevant to hiring contracting or licensing procedures. Authorization for Medical Report Name Address Social Security Number VA Number Date of Birth Date of Injury Service Record Branch of Service USA USN Rank USMC Military Service Number USCG Date Entered Service Date Released from Service Postal Medical Officer Name Mailing Address I the undersigned authorize the following hospitals and/or doctors to furnish the above mentioned postal medical officer all medical information concerning the following problems. It is understood that this/these report s will be furnished without cost to the US Postal Service. A photostat of this authorization will be as valid and effective as the original* Signature Witness Signature Printed or Typed Name Date Authorized Doctors/Hospitals Medical Problems Privacy Act Statement The collection of this information is authorized by 39 USC 401 1001. Completion of this form is voluntary. This information will be used to secure outside medical information necessary to process medical records which are kept on each postal employee. As a routine use this information may be disclosed to the Civil Service Commission Public Health Services HHS and to officials of other federal agencies responsible for federal benefit programs. Your failure to provide this information may result in your not receiving full consideration for a position*. Authorization for Medical Report Name Address Social Security Number VA Number Date of Birth Date of Injury Service Record Branch of Service USA USN Rank USMC Military Service Number USCG Date Entered Service Date Released from Service Postal Medical Officer Name Mailing Address I the undersigned authorize the following hospitals and/or doctors to furnish the above mentioned postal medical officer all medical information concerning the following problems. It is understood that this/these report s will be furnished without cost to the US Postal Service. A photostat of this authorization will be as valid and effective as the original* Signature Witness Signature Printed or Typed Name Date Authorized Doctors/Hospitals Medical Problems Privacy Act Statement The collection of this information is authorized by 39 USC 401 1001. It is understood that this/these report s will be furnished without cost to the US Postal Service. A photostat of this authorization will be as valid and effective as the original* Signature Witness Signature Printed or Typed Name Date Authorized Doctors/Hospitals Medical Problems Privacy Act Statement The collection of this information is authorized by 39 USC 401 1001. Completion of this form is voluntary. This information will be used to secure outside medical information necessary to process medical records which are kept on each postal employee. .

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