Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with DuPage Medical Group (Duly Health and Care) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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DuPage Medical Group (Duly Health and Care) fax number

(630) 873-8797

Release of Information (ROI) / Medical Records

Used for: Authorization for Release of Health Information / Medical Records Request

Fax destination details

Department
Release of Information (ROI) / Medical Records
Purpose
Authorization for Release of Health Information / Medical Records Request
Form
Authorization for Release of Health Information Form — Authorization for Release of Health Information Form
Address
1100 W 31st Street, Downers Grove, IL 60515
Voice phone
(630) 469-9200

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 all required patient information, specify the records to be released (e.g., radiology, lab results, charts), indicate date ranges if applicable, select delivery method (fax/email/pick up), and sign. Note that sensitive information may be released; the form also documents expiry and revocation rights.

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

Sources and verification

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