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AUTHORIZATION FOR RELEASE OF INFORMATION
The injured employee must clearly print his or her name on the patient line. 2. The injured employee must clearly print his or her name on the second line.
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Authorization for Release of Information
I (please print your name),. , desire to obtain employment with the Maryland Department of Transportation (MDOT). By my signature below, I authorize MDOT to
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AUTHORIZATION AND RELEASE OF MEDICAL
The following document contains important information about how we treat your medical and healthcare information and your rights as a client or patient.
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