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FD-465 (Rev; 5-45-84) ; ae, coh, VG) 7 AUTHORITY TO’ RELEASE MEDICAL INFORMATION I, Petra EF. BarasAs— . hereby authorize any Special Agent or ather authorized representative of the Federal Bureau of Investigation bearing this release or a copy tnereof, to obtain information available from my past or present medical records maintained at/by PY Me DICAL a “Faeiuery including those records relating to the treatment or care for drug abuse, alcoholism or psychiatric conditions. The release of these records is necessary for employment or investigative purposes. If for employment purposes with another Government agency, the information obtained may be disseminated by the FBI to other Government agency or agencies. | request that the custodian of such records in each instance permit my records in connection. therewith to be examined, copied or otherwise reviewed. : | | | also realize that this release is subject to my revocation. at any time except to the. extent that action has been taken in reliance thereon. Absent such revocation, | understand that this release is valid for one year from the date of signing. pate Yue 2 1985