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Brenner Children's Developmental and Behavioral Pediatrics fax number
(336) 713-7842
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Developmental and Behavioral Pediatrics
Used for: Medical records release / Authorization for Use or Disclosure of Protected Health Information (HIPAA authorization)
Fax destination details
- Department
- Developmental and Behavioral Pediatrics
- Purpose
- Medical records release / Authorization for Use or Disclosure of Protected Health Information (HIPAA authorization)
- Form
- HIPAA Authorization for Release of Protected Health Information — Authorization for Use or Disclosure of Protected Health Information (Release of Information)
- Address
- 3325 Silas Creek Parkway, Winston-Salem, NC 27103
- Voice phone
- 336-713-0678
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
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Complete patient name and date of birth, specify records to release, designate recipient, purpose, delivery method, and signature/date; fax to 336-713-7842; keep a copy for your records.
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