Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Gem State Dermatology before sending sensitive documents. FaxFlow is not affiliated with this organization.
Gem State Dermatology fax number
(208) 424-5072
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.
- Include a cover sheet and any case, member, claim, or form reference required.
- 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.
Sources and verification
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