Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Hartgrove Behavioral Health System before sending sensitive documents. FaxFlow is not affiliated with this organization.
Hartgrove Behavioral Health System fax number
(773) 413-1775
Medical Records
Used for: Release of patient information / medical records requests (Authorization to Release and Disclose Patient Information)
Fax destination details
- Department
- Medical Records
- Purpose
- Release of patient information / medical records requests (Authorization to Release and Disclose Patient Information)
- Form
- Authorization to Release and Disclose Patient Information — Hartgrove Behavioral Health System Authorization to Release and Disclose Patient Information
- Address
- 5730 W. Roosevelt Road, Chicago, IL 60644
- Voice phone
- 773-413-1778
- 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 name and DOB, provide recipient name and address, specify purpose and date range, select information to disclose, sign and date; the form notes HIPAA compliance and that the authorized records may be redisclosed; return via fax to the facility using the contact details on the form.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.