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Get Rrb Form G-197 2014-2024

Name Date of Birth RRB Claim Number Social Security Number **PLEASE READ BOTH PAGES OF THE ENTIRE FORM BEFORE SIGNING BELOW IN ITEM B** I voluntarily authorize and request disclosure (including paper, oral, and electronic interchange): OF: All my medical records; also educational records and other information related to my ability to perform tasks. This includes specific permission to release: 1. All records and other information regarding my treatment, hospitalization, and outpatient care.

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