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Get Employer Ohio Bwc Authorization To Release Medical Information

Authorization to Release Medical Information Instructions You can obtain this form online at www. bwc.ohio. gov Please print or type. List the provider s you are authorizing to release medical records in the space indicated on this form. Please sign and date the form and send it to the customer service office where your claim is located or to your self-insured employer. I understand I am authorizing the release of this information to the followin.

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