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New mexico authorization form

New mexico authorization form 2025

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The document is a Worker’s Authorization for Use and Disclosure of Health Records from the New Mexico Workers’ Compensation Administration. It allows injured workers to authorize health care providers to release their medical records related to workplace injuries or disabilities for the purpose of evaluating their workers' compensation claims. The form outlines the process, costs associated with copying records, and includes sections for specifying which records are to be released, as well as information about revocation of authorization.

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