![]() I hereby authorize the use or disclosure of my personal health information upon request by Sedgwick from all claim processors appointed by my employer, including but not limited to those who administer my employer’s Group Health, Short-Term Disability, Long-Term Disability, Workers’ Compensation and Employee Assistance Program (EAP). ![]() I certify all of the information above is to the best of my knowledge true, correct and complete. Sedgwick only needs one copy of this form, so please choose one method of delivery only.ĬERTIFICATION AND AUTHORIZATION FOR RELEASE OF INFORMATION STEP 2: Sign and return this form by FAX TO (818) 591-7664 OR by mail to Sedgwick, P.O. NOTE: Your Sedgwick claim number is mandatory for identification purposes. Landlord (Tenant) Recommendation Letter.
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