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Get PA PSRS-607 2012-2024

Nce Medical Records PSERS Health Program PSRS-607 (08/2012) Instructions: Please sign this form and send it to your physician. I, _____________________________________________________, authorize Name (please print or type) the Public School Employees’ Retirement System to receive copies of my hospital records, x-ray reports, specific test results, or any medical findings for the determination of my disability retirement benefit. Signature Date FOR PHYSICIAN’S INFORMATION ONLY Medical r.

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