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Dover Pediatrics, PLLC fax number
(603) 743-3345
Wrong or outdated? Report this number
Behavioral Health
Used for: Medical records release / transfer (PHI) communications to/from Dover Pediatrics
Fax destination details
- Department
- Behavioral Health
- Purpose
- Medical records release / transfer (PHI) communications to/from Dover Pediatrics
- Form
- Record Release Form — Dover Pediatrics Record Release Form
- Address
- 17 Old Rollinsford Rd., Ste 5, Dover, NH 03820
- Voice phone
- 603-742-4048
- Website
- Visit organization website
Before you send
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Authorization to release protected health information. Fill requester name, patient, recipient, purpose (transfer from/to Dover Pediatrics), and PHI to be released (medical and/or billing records; date range if applicable). Sign and date; indicate method of delivery. The form notes that it becomes effective immediately and expires one year from signature; photo ID may be required to pick up records.
Official form instructions are published as a downloadable file on the organization's website.
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