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Get and Sign 2 M 3 T 4 C Cdcr Ca 2010-2022 Form

Get and Sign 2 M 3 T 4 C Cdcr Ca 2010-2022 Form

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IF MEDICAL PAROLE REQUESTED BY INMATE’S FAMILY MEMBER OR DESIGNEE (PRINT LEGIBLY) REQUESTOR’S NAME: DATE OF REQUEST: RELATIONSHIP TO INMATE : SECTION 4: CONSENT FOR RELEASE OF MEDICAL INFORMATION CHECK ONE OF THE FOLLOWING: CONSENT GIVEN BY INMATE OR INMATE’S AUTHORIZED REPRESENTATIVE. CDCR FORM 7385 ATTACHED. INMATE UNABLE TO CONSENT AND DOES NOT HAVE AN AUTHORIZED REPRESENTATIVE TO CONSENT ON HIS/HER BEHALF. RELEASE OF MEDICAL INFORMATION HAS BEEN REQUESTED THROUGH THE COURT. PRINT OR...
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