Alabama Department of Public Health, Wellness Program (Public Education Employees' Health Insurance Program - PEEHIP) fax number

Fax destination details

Department

APDH Wellness Program (Wellness Division, Alabama Department of Public Health)

Purpose

Disclosure of Protected Health Information (PHI) under HIPAA for PEEHIP Wellness forms (PHI disclosures such as PEEHIP Screening and Influenza Vaccine Form).

Form

HIPAA Authorization — Authorization for Disclosure of Protected Health Information

Address

APDH Wellness Program, 201 Monroe Street, Suite 986, Montgomery, AL 36104

Voice phone

+1-334-206-9437; +1-844-842-2954

Website

Visit organization website

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.

Complete member name, date of birth, SSN (last four), and select the form requested (PEEHIP Screening or PEEHIP Influenza Vaccine Form). Indicate the recipient's name, telephone, and address. Specify expiration (default is 90 days if none provided) and sign/date. Send to APDH Wellness Program at 201 Monroe Street, Suite 986, Montgomery, AL 36104.

Official form instructions are published as a downloadable file on the organization's website.