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U.S. DOD Form dod-da-5009 MEDICAL RECORD RELEASE AGAINST MEDICAL ADVICE For use of this form, see AR 40-68; proponent agency is the Office of The Surgeon General STATEMENT OF PATIENT RELEASING HOSPITAL/CLINIC
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If applicable, provide information on your military service or affiliation. This may include your branch of service, rank, and any relevant details regarding your military history.
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Who needs US DOD Form DOD-DA-5009:

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US DOD Form DOD-DA-5009 may be required by individuals who are affiliated with the United States Department of Defense (DOD). This includes military personnel, civilian employees, and contractors working within the DOD's jurisdiction.
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It is essential to refer to the specific instructions or consult with the relevant authority to determine whether the completion of DOD Form DOD-DA-5009 is necessary in your particular situation.
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