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City of Hope National Medical Center fax number

(626) 218-8443

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Health Information Management Services (ROI)

Used for: Release of Information requests for medical records

Fax destination details

Department
Health Information Management Services (ROI)
Purpose
Release of Information requests for medical records
Form
PHI Authorization (Authorization to Use and Disclose Protected Health Information) — Authorization to Use and Disclose Your Protected Health Information
Address
1500 East Duarte Road, Duarte, CA 91010
Voice phone
626-218-2446

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 the PHI authorization form with patient identifying information, specify what records to release, who may receive them, purpose, and any expiration; submit via the City of Hope ROI fax number 626-218-8443 or follow the online/mail options listed by City of Hope.

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