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Last Updated: Dec 20, 2023, 09:42 AM
Form Title: Medical Information Release
Description: Form to be signed by employee to authorize the release of information to the Student Health Center.
Usage Notes: An employee signs this form to release medical information to the Student Health Center on behalf of Human Resources to determine eligibility and duration of Family and Medical Leave or Extended Sick Leave.
Use Documentation: None available
To be used by: Campus Use
Posted on: 02 Mar 2021
Posting by: Human Resources
Contact email: formadm@siu.edu
Form ID: hro1060