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Medical Authorization Form

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Date of Record: 04/16/25 11:42

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WC-2 Medical Authorization Form

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1 N.W. Martin Luther King, Jr. Boulevard
Evansville, Indiana 47708-1833
Phone: (812) 435-5000

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Vanderburgh County, Indiana

1 N.W. Martin Luther King, Jr. Boulevard
Evansville, Indiana 47708-1833
Phone: (812) 435-5000