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Banner Health Clinic Orthopedic Surgery fax number

(480) 543-6725

Orthopedic Surgery

Used for: Medical records transfer/requests; patient communications

Fax destination details

Department
Orthopedic Surgery
Purpose
Medical records transfer/requests; patient communications
Form
Authorization for Release of Protected Health Information (PHI) — Authorization to Use or Disclose Protected Health Information
Address
1920 N Higley Rd, Ste 206, Gilbert, AZ 85234-1624
Voice phone
480-543-6700

Before you send

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  • 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.
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Complete with patient name, date of birth, dates of service, records to release, and recipient; sign and date. If you refuse, the release may be restricted.

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