Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Froedtert Hospital before sending sensitive documents. FaxFlow is not affiliated with this organization.
Froedtert Hospital fax number
(414) 259-1244
Health Information Management (ROI) / MyChart Proxy (Adult Proxy)
Used for: Submission of the MyChart Consent - Adult Proxy (Form #50494) and release of protected health information through Froedtert Health's HIM ROI workflow.
Fax destination details
- Department
- Health Information Management (ROI) / MyChart Proxy (Adult Proxy)
- Purpose
- Submission of the MyChart Consent - Adult Proxy (Form #50494) and release of protected health information through Froedtert Health's HIM ROI workflow.
- Form
- Form #50494 — MyChart Consent - Adult Proxy
- Address
- Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226-3596
- Voice phone
- 414-805-2909
- 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 out the Adult Proxy Authorization (MyChart Consent - Adult Proxy, Form #50494). Provide proxy details, patient information, and signatures; then fax to 414-259-1244 or mail to Froedtert Health HIM ROI, 9200 W Wisconsin Ave, Milwaukee, WI 53226-3596. For questions, contact Health Information Management at 262-836-2510.
Official form instructions are published as a downloadable file on the organization's website.
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