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Kingwood Pines Hospital fax number

(281) 312-1983

Used for: Release of Protected Health Information (PHI) via fax; medical records release

Fax destination details

Purpose
Release of Protected Health Information (PHI) via fax; medical records release
Form
Authorization for Release of Protected Health Information (PHI) — Authorization for Release of Protected Health Information
Address
2001 Ladbrook Drive, Kingwood, TX 77339
Voice phone
281-440-1022

Before you send

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  • 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 purpose and dates of service, indicate which records to release, sign and date; note potential copying fees and HIPAA/privacy requirements.

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