Bp a521 060 2025

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4.3 out of 5

54 votes

The document is an authorization form from the U.S. Department of Justice, Federal Bureau of Prisons, allowing inmates to request the release or obtain their medical information. It includes details such as the inmate's personal information, the purpose for requesting the information, and specific types of medical records to be released. The form emphasizes that signing is voluntary and outlines the rights regarding confidentiality and revocation of consent.

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Click ‘Get Form’ to open the bp a521 060 in the editor.
Begin by entering the inmate's name, register number, date, date of birth, and social security number in the designated fields.
Indicate whether you authorize the Federal Bureau of Prisons to obtain or release information by checking the appropriate box.
Fill in the contact details of the person or facility that should receive or provide the medical information, including name, address, city, state, and zip code.
Specify the reason for releasing this information by selecting from options like 'Continuation of care' or providing another reason in the space provided.
Select which specific medical records you wish to be released or obtained by checking all relevant boxes under 'Information to be Released/Obtained'.
Sign and date the form at the bottom to authorize the release of your medical information.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (127 Votes)
2005	4.3 Satisfied (54 Votes)

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