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2012 pa medical records print-2026
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- Click ‘Get Form’ to open the 2012 PA Medical Records Print in the editor.
- Begin by entering your name in the designated field. Ensure that you print or type your name clearly for accurate processing.
- Next, sign the form in the signature section. This is crucial as it authorizes the Public School Employees’ Retirement System to access your medical records.
- Fill in the date of your signature to indicate when you authorized this release.
- For physician’s information, confirm that the address for sending medical records is correctly listed as: Public School Employees’ Retirement System, Disability Section, 5 N 5th Street, Harrisburg, PA 17101-1905.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.8 Satisfied (120 Votes) |
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Jan 5, 2026 There may be a fee for providing copies of the medical record: $2/page (1-20 pages) $1.48/page (21-60 pages) $0.52/page (61+ pages) $2.95/page
A request to the Department of Health (Department) for medical records must be completed by submitting a valid Authorization for Release of Records form