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Gem State Dermatology fax number
(208) 424-5072
Wrong or outdated? Report this number
Dermatology
Used for: Release of Protected Health Information (PHI) / Release of Medical Information (ROI) requests to Gem State Dermatology
Fax destination details
- Department
- Dermatology
- Purpose
- Release of Protected Health Information (PHI) / Release of Medical Information (ROI) requests to Gem State Dermatology
- Form
- PHI/ROI Release of Information Form — Authorization for Release of Protected Health Information (PHI) and Release of Medical Information (ROI)
- Address
- 388 E. ParkCenter Blvd., Boise, ID 83706
- Voice phone
- (208) 424-9101
- 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.
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- Keep the delivery confirmation with your submission records.
Complete patient information, specify which records to release, date range, destination, and method (fax/mail). The form notes HIPAA compliance and states the authorization is valid for 180 days.
Official form instructions are published as a downloadable file on the organization's website.
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