Revocation of Limited Release of Medical/Health Care Information Forms
| Form Name | Revocation of Limited Release of Medical/Health Care Information |
| Form # | WCB-220-R |
| Form Revision | (eff 09/04/2023, rev 10/23/2023) |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Maine |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |