CM-936 Authorization for Release of Medical Records – Fillable PDF

The CM-936 is the official Authorization for Release of Medical Records used by the U.S. Department of Labor’s Office of Workers' Compensation Programs. It allows the agency to obtain medical information needed to process workers‑compensation claims.

What Is the CM-936 Form?

This form grants permission for physicians, hospitals, or other health providers to share a claimant’s medical records with the Department of Labor. It is required for both active claimants and the estates of deceased miners.

How to Complete the CM-936 Online with Formize

Instead of downloading the PDF and editing it in a separate program, you can fill the form directly on our site using the Formize PDF Filler app. Follow the simple steps below:

• Step 1: Click the "Fill out this form" button on this page.
• Step 2: Wait a few seconds while the Formize PDF Filler loads the CM-936 document.
• Step 3: Enter the requested information in each fillable field. The interface highlights required fields.
• Step 4: Review your entries for accuracy.
• Step 5: Click Submit to download a completed PDF or print it for mailing.

Common Mistakes to Avoid

Even a small error can delay your workers‑compensation claim. Keep these tips in mind:

• Do not leave required fields blank – the form will not validate.
• Use the exact legal name as it appears on the claimant’s identification.
• Provide a current address and a reliable phone number for follow‑up.
• Sign the form in the designated signature box; an electronic signature is accepted when using Formize.
• Check the date format (MM/DD/YYYY) before submitting.

Where to Submit the Completed Form

After you have saved the completed CM-936 PDF, mail it to the Office of Workers' Compensation Programs at the address listed on the form, or upload it through the Department of Labor’s online portal if you have an account.

Need help? Review the FAQs below or contact your local workers’ compensation office for additional guidance.