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Froedtert Hospital fax number
(414) 259-1244
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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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