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Authorization to Release Health Records (F-011). Revised: April 2017.Revised: November 2020. Credit Card Authorization Form. Completed Applications may be submitted via email or mail. Information released will include: name, address, date of birth, driver license information and driver history. Submitting New and Renewal Applications. Submitting New and Renewal Applications. Please complete this form at your convenience and bring it with you to your scheduled appointment date. Total employment in fourth quarter 2022 was down approximately 3,600 jobs from fourth quarter 2019.