Verification Lookup Portal
Providers for Anderson Hospital
Anderson Hospital
Anderson Rehabilitation Institute
Anderson Surgery Center
Community Hospital of Staunton
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Requester Name
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Requester Title
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Requester Organization
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Requester Address
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Requester City, State, Zip
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I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies Anderson Healthcare and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such Anderson Healthcare and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with Anderson Healthcare.
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Provider Last Name
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