Consent to Release Information Forms
| Form Name | Consent to Release Information |
| Form # | BWC-1192 C-72 |
| Form Revision | (Rev. Nov. 30, 2023) |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Ohio |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |