Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Elliot Health System (The Elliot Hospital) before sending sensitive documents. FaxFlow is not affiliated with this organization.
Elliot Health System (The Elliot Hospital) fax number
(603) 663-1856
Health Information Management Department / Medical Records
Used for: PHI release requests and amendments; submission of Authorization to Release Protected Health Information forms and Amendment/Correction forms
Fax destination details
- Department
- Health Information Management Department / Medical Records
- Purpose
- PHI release requests and amendments; submission of Authorization to Release Protected Health Information forms and Amendment/Correction forms
- Form
- Authorization for Release of Protected Health Information — Authorization to Release Protected Health Information (PHI)
- Address
- One Elliot Way, Manchester, NH 03103
- Voice phone
- 603-663-2341
- 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.
Download and complete the Authorization to Release PHI form; ensure the form is legible and complete. Sign and date; if you are signing on behalf of the patient, provide appropriate legal authority. Send the completed form by mail or fax to the Elliot Health System Medical Records Department. The form is available in English and Spanish. For faster processing, use the online form if available. You may also call 603-663-2341 for assistance.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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