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Medical release form — Indiana

Use this form to request your medical records from American Health Network (AHN) or to ask AHN to send your records to another facility.

Where to send the completed form:

  • Please find your health care provider's address and phone number on this website. Call the phone number to get the correct fax number.
  • If your provider is no longer with American Health Network, please complete the form and mail it to:

American Health Network
Attention: Medical Records Department
10689 N. Pennsylvania St., Suite 200
Indianapolis, IN 46280