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Forms - ACADEMIC RELEASE OF INFORMATION

Home   Forms   ACADEMIC RELEASE OF INFORMATION
ACADEMIC RELEASE OF INFORMATION (File: ACADEMIC AUTHORIZATION.pdf)
Date Posted: 08/10/18
AUTHORIZATION FOR RELEASE OF EMPLOYMENT INFORMATION (File: AUTH FOR RELEASE OF EMPLOYMENT INFO.pdf)
Date Posted: 10/08/18
BEAUMONT AUTHORIZATION (File: BEAUMONT AUTHORIZATION.pdf)
Date Posted: 08/10/18
BLUE CROSS BLUE SHIELD AUTHORIZATION (File: BLUE CROSS BLUE SHIELD AUTHORIZATION.pdf)
Date Posted: 10/30/19
CLEVELAND CLINIC AUTHORIZATION (File: CLEVELAND CLINIC AUTHORIZATION.pdf)
Date Posted: 08/10/18
CLEVELAND CLINIC RADIOLOGY AUTHORIZATION (File: CLEVELAND CLINIC RADIOLOGY.pdf)
Date Posted: 10/30/19
CVS PHARMACY (File: CVS PHARMACY.pdf)
Date Posted: 08/10/18
DEPT OF VETERANS AFFAIRS AUTHORIZATION (File: DEPT VETERAN AFFAIRS FORM 21-0845 & 21-4138.pdf)
Date Posted: 10/11/18
DETROIT MEDICAL CENTER AUTHORIZATION (File: DETROIT MEDICAL CENTER AUTHORIZATION.pdf)
Date Posted: 08/10/18
GENESYS REGIONAL MEDICAL CENTER AUTHORIZATION (File: GENESYS AUTHORIZATION.pdf)
Date Posted: 08/16/18
HEALTH ALLIANCE PLAN AUTHORIZATION (File: HAP AUTHORIZATION.pdf)
Date Posted: 08/16/18
HENRY FORD HEALTH AUTHORIZATION (File: HENRY FORD HEALTH SYSTEM AUTHORIZATION.pdf)
Date Posted: 10/30/19
HUMANA AUTHORIZATION (File: HUMANA AUTHORIZATION.pdf)
Date Posted: 10/30/19
IRS 4506 - COPY OF TAX RETURNS (File: IRS FORM 4506.pdf)
Date Posted: 01/24/23
IRS 4506-T TRANSCRIPT OF TAX RETURNS (File: IRS 4506-T TRANSCRIPT OF TAX RETURNS.pdf)
Date Posted: 10/30/19
KROGER PHARMACY AUTHORIZATION (File: KROGER PHARMACY.pdf)
Date Posted: 10/30/19
MAYO CLINIC AUTHORIZATION (File: MAYO CLINIC AUTHORIZATION.pdf)
Date Posted: 08/10/18
McLAREN AUTHORIZATION (File: McLAREN HEALTHCARE.pdf)
Date Posted: 08/10/18
MEDICARE AUTHORIZATION (File: MEDICARE AUTHORIZATION.pdf)
Date Posted: 09/19/18
MERIDIAN HEALTH AUTHORIZATION (File: MERIDAN HEALTH AUTHORIZATION.pdf)
Date Posted: 10/30/19
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