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Form EHS-742.4 Authorization for Release and Disclosure of Medical Information to a State Agency - New York
What Is Form EHS-742.4?
This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form EHS-742.4?
A: Form EHS-742.4 is an Authorization for Release and Disclosure of Medical Information to a State Agency.
Q: What is the purpose of Form EHS-742.4?
A: The purpose of Form EHS-742.4 is to allow the release and disclosure of an individual's medical information to a State Agency in New York.
Q: Who needs to fill out Form EHS-742.4?
A: Any individual who wants to authorize the release and disclosure of their medical information to a State Agency in New York needs to fill out Form EHS-742.4.
Q: What is the importance of Form EHS-742.4?
A: Form EHS-742.4 is important as it grants permission for the release and disclosure of an individual's medical information, which can be crucial for certain transactions or proceedings with a State Agency.
Form Details:
- Released on April 1, 2018;
- The latest edition provided by the New York State Department of Civil Service;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form EHS-742.4 by clicking the link below or browse more documents and templates provided by the New York State Department of Civil Service.
