Download Fillable da Form 4876

You can download free da 4876 form in many formats from our site: da 4876 fillable pdfda 4876 fillable wordblank da 4876 (ibm lotus) :

desc: request and release of medical information to communications media

note:

  • requires privacy act statement (ar 21)
  • only produced in electronic media

Download Fillable da Form 4876