F608 2025

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511 votes

The document is a General Authorization for Medical Information form used by NYCERS, allowing the organization to obtain medical information from members applying for disability retirement. It emphasizes the importance of privacy and outlines the member's rights regarding their medical records, including specific provisions related to sensitive health information such as HIV/AIDS. Members must understand and consent to the use and disclosure of their medical information before signing.

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Click ‘Get Form’ to open the f608 in the editor.
Begin by entering your Member Number and the last four digits of your Social Security Number. This information is crucial for identification purposes.
Fill in your Date of Birth in the format [MM/DD/YYYY], followed by your First Name, Middle Initial, and Last Name.
Provide your complete address, including Apt. Number, City, State, and Zip Code to ensure accurate communication.
Indicate the Name of the Hospital or Medical Group you are authorizing to release medical information.
List the Dates of treatment/service in the specified format [MM/DD/YYYY]. Ensure all relevant dates are included for comprehensive coverage.
Specify the expiration date of this authorization using the same date format.
Initial each statement to confirm your understanding of the form's implications regarding privacy and disclosure of medical records.
Finally, sign and date the form at the bottom to validate your authorization.

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (511 Votes)

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