Teachers Retirement System of Georgia members applying for disability retirement send this one-page request to every hospital or clinic that treated or diagnosed them in the last 12 months. Medical records staff, rather than the treating physician, usually handle it: the facility gathers the listed records and mails them straight to TRS, where they support the disability decision alongside the DB-3 Physician's Report.
The member completes the top section with identifying details, treatment and discharge dates, the institution's name, and a signed authorization releasing all medical records, including psychiatric and psychological records. The hospital or clinic follows the Instructions to Hospital/Clinic block and sends the requested records.
Download the current version from the source each time; forms change without notice.
Hospital/Clinic Report
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The member fills in the top section, including treatment dates, the facility's name and a signed release of medical information, then forwards it to the hospital or clinic. Medical records staff at that facility gather the requested records and send them to TRS. The treating physician's own opinion goes on a separate form, the DB-3 Physician's Report.
One for each hospital or clinic where the member was treated or diagnosed in the last 12 months. TRS asks members to send a copy of the report to every such facility, and each facility returns its own records directly to TRS for the disability retirement review.
The member does. The form instructs the hospital or clinic to bill the person named on it for any charges related to the request, and TRS states that obtaining the medical information needed for a disability retirement decision is the member's responsibility and expense.