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Get UT 205 2019-2024

Your possession. I authorize the Industrial Accidents Division to release this information to the requesting party, for the purposes of verifying, evaluating, and managing my industrial claim. By signing this form the claimant is put on notice that his/her records, including medical records, are being made available to the requesting party. This form complies with the state Government Records Access & Management Act (GRAMA). Records Requested: Date of Injury Listed Only Records for All Injuries.

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