Maryland Worker’s Comp. Medical Release Form

The link below is the medical release form from the Maryland Worker’s Compensation website.  If Baltimore County is requesting medical records for any injury, use this form ONLY.  Do not use any forms sent to you.

In filling out the form, fill in your name and birth date.

For the section that says “Specify part or parts of body or medical condition”  :

“medical records relating to the injury to my (specify body part or medical condition) on (date)

Any questions please contact the lodge or consult your worker’s compensation attorney.

Medical Release Form