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OMB No. 30950039 Expires xx/xx/XXX
REQUEST FOR INFORMATION NEEDED TO LOCATE MEDICAL RECORDS
WHEN TO USE THIS FORM: Use this form to request the following categories of medical records from the National
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When to use this refers to the circumstances or situations in which this particular form or document should be utilized.
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The purpose of when to use this is to collect and report specific information for a particular purpose or compliance requirement.
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