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Get Ssa-4815 2023-2024

S (HIV) INFECTION The individual named below has filed an application for a period of disability and/or disability payments. If you complete this form, your patient may be able to receive early payments. (This is not a request for an examination, but for existing medical information.) MEDICAL RELEASE INFORMATION Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)," attached. I hereby authorize the medical source named below to release or disclose to.

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