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Asheville Women's Medical Center fax number

(828) 253-7382

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Medical Records

Used for: Medical records request / PHI disclosure authorization

Fax destination details

Department
Medical Records
Purpose
Medical records request / PHI disclosure authorization
Form
Patient Authorization for Use and Disclosure of Protected Health Information
Address
143 Asheland Avenue, Asheville, NC 28801
Voice phone
828-258-9191

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 in patient and recipient details, specify the information to disclose, purpose, expiration (one year from signing), and sign; return to Privacy Officer at 143 Asheland Avenue, Asheville, NC 28801. A fee may apply for copying records. This authorization will automatically expire one year from the date signed.

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

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