The Nih 527 form is an application to request a waiver of the two-year foreign residence requirement for J-1 visa holders. The form must be submitted by the applicant, and the decision to grant or deny the waiver is made at the discretion of U.S. Citizenship and Immigration Services (USCIS). The waiver may be granted if there is a compelling reason why the applicant cannot return to their home country after completing their program in the United States. There are several factors that USCIS will consider when making this determination, including whether or not the applicant has strong family ties in their home country and whether they would experience hardship if they were forced to leave the United States.
The table includes specifics of the nih 527 form. You might want to look at it prior to filling out the form.
| Question | Answer |
|---|---|
| Form Name | Nih 527 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | nih form 527, nih medical records, nih527, nih 527 form |
MEDICAL RECORD
Authorization for the Release of Medical
Information
INSTRUCTIONS: Complete this form in its entirety and forward the original to the address below: Please complete a separate form for each requestor
NATIONAL INSTITUTES OF HEALTH |
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ATTN: MEDICAL RECORD DEPARTMENT |
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MEDICOLEGAL SECTION |
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10 CENTER DRIVE, MSC 1192 |
TELEPHONE: |
(888) |
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BLDG 10, ROOM 1N205 |
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(301) |
(local calls) |
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BETHESDA, MD |
FACSIMILE: |
(301) |
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IDENTIFYING INFORMATION:
Patient Name
Daytime Telephone
Date of Birth
REQUESTOR INFORMATION: Information is to be released to the following individual or party:
Name |
Telephone |
Address
Fax Number
City |
State |
Zip Code |
Country |
*Please note that a patient may designate up to two outside care providers to have permanent authorization to obtain copies of their medical records. This authorization may be revoked at any time upon your request. If you would like the above named care provider to have such access or update existing care providers, please choose one of the following:
Please give the above named care provider authorization to my medical records
Please replace _____________ (existing authorization) with the above named care provider
Please remove the above named care provider’s authorization
The purpose or need for disclosure: ________________________________________________________________
Date Range of Information to be Released: from |
to |
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(month/year) |
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(month/year) |
Please check specific information to be released: |
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Discharge Summary
History & Physical
Operative Reports
Outpatient Progress Notes
Other (Please Specify):
Consultation Reports
Pulmonary Function Tests
Tissue Exam Reports
Nuclear Medicine Reports Nuclear Medicine CD Images (bone scan, etc.)
Heart Diagnostics
Radiology Reports Radiology CD Images
Lab Results
AUTHORIZATION: Permission is hereby granted to the National Institutes of Health Clinical Center to release medical information to the individual/organization as identified above.
(Note: submission of this form authorizes the release of the information specified within one year from date of signature.)
Patient/Authorized Signature
Print Name
Date
Patient Identification
Authorization for the Release of Medical Information
P.A.
File in Section 4: Correspondence