Copper Springs East (Gilbert), Lifepoint Health fax number

Fax destination details

Department

HIM/Medical Records Department

Purpose

Medical Records Release / Consent to Release MH & SUD Records

Form

Consent to Release MH & SUD Records — Consent to Release MH & SUD Records

Address

Copper Springs East, 3755 Rome Street, Gilbert, AZ 85297

Voice phone

480-5667-5500

Website

Visit organization website

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 name, date of birth, dates of treatment, programs to release, and recipient information; indicate what information to release; the form notes HIPAA and 42 CFR Part 2 protections and that the consent expires 90 days after the date of release unless otherwise noted. Records can be released by mail, pickup, or fax. The facility requires identity verification when records are released.

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