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*C0017* 1 Form×C0017 Page 1of M/C× 801 N. State Street Greenfield, IN 46140 P: (317) 4684407 F: (317) 4684309 V/S# AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS/IMAGES AFFIX MEDICAL RECORD/ACCOUNT

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Step 1: Start by visiting the official website of Hancock Regional Hospital.

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