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Franciscan Health fax number

(219) 845-7139

Medical Records

Used for: Submitting requests for medical records and imaging; provider letterhead requests; release of information

Fax destination details

Department
Medical Records
Purpose
Submitting requests for medical records and imaging; provider letterhead requests; release of information
Form
Authorization form — Release of Information to Third Party Authorization Form
Address
5454 Hohman Ave, Hammond, IN 46320
Voice phone
219-932-2300

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 out the authorization form with patient identifying details, locations/records to be released, purpose, and expiration; sign and date; fax to 219-845-7139 or email MedicalRecords@FranciscanAlliance.org; fees may apply; expiration is typically 60 days unless otherwise specified

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