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Get VT DOL 7 2012

VERMONT WORKERS’ COMPENSATION MEDICAL AUTHORIZATION NOTE: Title 21 VSA §655a requires all providers to utilize and comply with this medical release authorization form when seeking or providing medical information relative to a workers’ compensation claim. Workers Compensation claims are expressly exempted from the terms and provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR 164.512(1). A copy of 21 VSA §655a is included with this form (see Page 2 .

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