A handcuffed North Carolina inmate convicted of murdering a 1-year-old girl escaped from custody during a medical appointment — and remains on the lam Wednesday.

Ramone Alston, 30, bolted from the parking lot of UNC Hospital Hillsborough Campus Tuesday morning, prompting a frantic 680-acre search around the facility, with officials begging local residents to remain vigilant, ABC 11 reported.

Alston somehow broke free of his leg restraints and ran into the adjacent woods just after 7 a.m. Tuesday, officials said. He still had handcuffs on at the time.

Officials are asking for “any signs that Mr. Alston may have been there — any footprints, any discarded remains, handcuffs, attire, anything that we can find that would confirm a direction of travel and how he may have evaded capture,” Orange County Emergency Services Director Kirby Saunders said.

Alston was convicted of shooting and killing 1-year-old Maleah Williams on Christmas Day in 2015 in Chapel Hill. Children were playing outside with their gifts when someone started firing shots, Williams’ mother told the station. She was running away when she realized her daughter had been struck.

While there have been multiple sightings of Alston, none have been confirmed, Orange County Sheriff Charles Blackwood said.

“No concrete leads at this time,” Blackwood said. “Somebody knows out there that this was planned, and they know who’s involved in it.”

Blackwood said he went to school with Alston’s father and has known the escaped criminal his whole life.

“I’ve known Ramone since he was born. He was a troubled child, and he’s been involved in criminal activity since he was a juvenile. He’s extremely cagey; he’s extremely dangerous, and he has nothing to lose.”

The Orange County Sheriff’s Office said Alston was wearing a gray T-shirt, brown pants and white New Balance tennis shoes at the time of his escape.

The department upped a $25,000 reward to $35,000 for information leading to his location and recapture.