Authorization to Disclose Workers' Compensation Records - labor mo 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name in the first section, authorizing the disclosure of your workers' compensation records. Ensure you include the last four digits of your social security number.
3. In the next section, specify the individual or organization authorized to make the disclosure, which is typically the Missouri Department of Labor and Industrial Relations.
4. Detail the type of records you wish to disclose. Strike through any records that should not be included, ensuring clarity on what information is shared.
5. Indicate any restrictions on record release by specifying a date range if applicable.
6. Initial next to the statement regarding sensitive information to indicate whether you authorize its disclosure.
7. Provide details about who will receive these records and for what purpose in the designated fields.
8. Sign and date the form at the bottom, ensuring all required fields are completed before submission.

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