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Arsenault Dermatology fax number
(941) 907-0493
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Dermatology
Used for: Medical records release / patient information requests
Fax destination details
- Department
- Dermatology
- Purpose
- Medical records release / patient information requests
- Form
- HIPAA authorization to release medical information — Authorization for the Release of Protected Health Information
- Address
- 8926 77th Terrace East, Suite 101, Lakewood Ranch, FL 34202
- Voice phone
- 941-907-0222
- 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.
Refer to the Authorization for the Release of Protected Health Information form. Complete patient name, date of birth, contact information, and specify whether records are to be sent to or obtained from another entity. Signature and date required. Please allow 7 to 10 business days for records to be copied. The authorization expires 180 days after signing unless revoked earlier.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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