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 section
E
1. “The member of the body that was injured”  (e.g “right shoulder” or right ankle”)
2. “The description of how the injury occurred” (e.g. “dog bite”, “fell chasing a suspect”
3. “The description of how the occupational disease occurred”  (call the FOP or attorney for verbiage)

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

Medical Release Form