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Columbus Pediatric Associates, PC fax number

(706) 221-4620

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Pediatrics

Used for: Authorization for release of health information / medical records requests

Fax destination details

Department
Pediatrics
Purpose
Authorization for release of health information / medical records requests
Form
Authorization for use / Release of Health Information — Authorization for use / Release of Health Information
Address
500 Brookstone Centre Pkwy, Building-100, Columbus, GA 31904
Voice phone
706-221-4602

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Complete the entire form. Indicate which records to release, where to obtain or send records, and include patient details (name, DOB). Sign and date. The office notes a $5.00 charge for mailing records; copies to a parent may incur a fee after the first free copy; records typically take up to 2 weeks. If mailing, provide the recipient address and a contact number.

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