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Gwinnett OB-GYN Associates, P.C. fax number
(770) 985-2683
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Medical Records
Used for: Medical records release / records request (authorization to request a copy of medical records to be forwarded)
Fax destination details
- Department
- Medical Records
- Purpose
- Medical records release / records request (authorization to request a copy of medical records to be forwarded)
- Form
- AUTHORIZATION TO REQUEST A COPY OF MY MEDICAL RECORDS TO BE FORWARDED — Authorization to Request a Copy of My Medical Records to Be Forwarded
- Address
- 1700 Tree Lane Road, Suite 290, Snellville, GA 30078
- Voice phone
- 770-972-0330
- 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 in patient information; specify current location of records and recipient; indicate which records to copy; sign; this authorization is valid for 90 days; may involve confidential information (psychiatric/HIV) as noted on the form.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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