Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Hattiesburg Clinic, PA before sending sensitive documents. FaxFlow is not affiliated with this organization.
Hattiesburg Clinic, PA fax number
(601) 268-5767
Release of Information (ROIS)
Used for: Medical records request / Authorization for Disclosure of Medical Information
Fax destination details
- Department
- Release of Information (ROIS)
- Purpose
- Medical records request / Authorization for Disclosure of Medical Information
- Form
- Authorization for Disclosure of Medical Information — Authorization for Disclosure of Medical Information
- Address
- 415 South 28th Avenue, Hattiesburg, MS 39401
- Voice phone
- 601-579-5276
- 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 all fields; sign and date; fax to ROIS at 601-268-5767; if faxed, full payment for medical record copies is required before obtaining records.
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