Release of Medical Information Form 2018 PDF download: Authorization For Release of Medical Information – United States … www.dol.gov Authorization For Release of Medical. Information (Black Lung Benefits). U.S. Department of Labor. Office of Workers' Compensation Programs. Division of Coal Mine Workers' Compensation. OMB No. 1240-0034. Expires: 11-30-2018. 1. Miner's First Name. M. I. Last […]
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