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Get the free Privacy Act; System of Records: Medical Records, State-24.

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2015 Medical Release & Permission Form Printed Name of Applicant: ___ Birth date: ___ (circle) Male or FemaleGrade: ___Address: ___ City: ___ Applicant Cell Phone:___Email: ___ Medical Insurance Company:___
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The Privacy Act System is a system of records maintained by federal agencies containing personally identifiable information.
Federal agencies are required to file and maintain Privacy Act Systems.
Privacy Act Systems can be filled out through the agency's designated Privacy Act Officer.
The purpose of the Privacy Act System is to ensure the protection and proper handling of personally identifiable information.
Personally identifiable information such as names, addresses, social security numbers, etc. must be reported on Privacy Act Systems.
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