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Acacia Family Medical Group fax number

(831) 753-9717

Medical Records

Used for: Medical records release /PHI disclosure (Authorization for Release of Medical Records)

Fax destination details

Department
Medical Records
Purpose
Medical records release /PHI disclosure (Authorization for Release of Medical Records)
Form
PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
Address
400 East Romie Lane, Salinas, CA 93901; 8036 San Miguel Canyon Rd, Prunedale, CA 93907
Voice phone
831-770-0123

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Fill patient/guardian name and contact; specify the records to be released, purpose (clinical care), expiration date, and signature; submit to Privacy Officer at 400 E. Romie Lane, Salinas, CA 93901.

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