Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Horizon Eye Care PA before sending sensitive documents. FaxFlow is not affiliated with this organization.
Horizon Eye Care PA fax number
(704) 405-4093
HIPAA Officer (Privacy Officer)
Used for: Medical records release / release of protected health information (PHI); submission of Medical Records Release Form via fax
Fax destination details
- Department
- HIPAA Officer (Privacy Officer)
- Purpose
- Medical records release / release of protected health information (PHI); submission of Medical Records Release Form via fax
- Form
- Authorization/Release form — Medical Records Release Authorization Form
- Address
- 135 South Sharon Amity, Suite 100, Charlotte, NC 28211
- Voice phone
- 704-405-4108
- 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 out the Medical Records Release Authorization Form, sign and date, specify the PHI to be released and the recipient, then fax to 704-405-4093.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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