Horizons Mental Health Center, Inc. fax number

Fax destination details

Purpose

General communications and the exchange of protected health information (e.g., medical records requests, intake forms, scheduling updates, and releases of information) between you and Horizons Mental Health Center.

Form

Authorization for the Use and Disclosure of Protected Health Information — Authorization for the Use and Disclosure of Protected Health Information (ROI)

Address

1600 N Lorraine Street, Suite 202, Hutchinson, KS 67501

Voice phone

620-663-7595

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.

Print and complete the form with patient information, specify the recipient and purpose, sign and date, then fax back to Horizons Mental Health Center. Use this form to request or disclose protected health information related to mental health services.

Official form instructions are published as a downloadable file on the organization's website.