RI DLT, Temporary Disability Insurance~Temporary Caregiver Insurance
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Fact Sheet
Frequently Asked Questions
Brochure for QHP's
Medical Release Form
Independent verses Follow-Up Care
Top Medical Durations
Partial Return-to-Work





Medical Release Form
for Qualified Healthcare Providers

If you require an Authorization for Release of Medical Information in order to provide information about the illness or injury that your patient is applying for benefits for, the Authorization will be mailed to your patient. The patient is instructed to sign the Authorization and deliver it to his/her healthcare provider. The Statement of Attending Physician is mailed directly to the healthcare provider and is to be returned to TDI. For your convenience, you may download additional copies of the Authorization for Release of Medical Information here.

Medical Release Form (in pdf)



 
RI Department of Labor and Training
Temporary Disability Insurance
P.O. Box 20100,
Cranston, RI 02920
-0941
Phone: (401) 462-8420
Fax (401) 462-8466
TTY via RI Relay: 711
1/15/14 MDF
State Seal
  DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request