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Knoxville Rheumatology PLLC fax number

(865) 444-6196

Medical Records

Used for: Authorization for Release of Medical Records

Fax destination details

Department
Medical Records
Purpose
Authorization for Release of Medical Records
Form
Authorization for Release of Medical Records — Authorization for Release of Medical Records
Address
2072 Lakeside Center Way, Knoxville, TN 37922
Voice phone
865-246-6580

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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 out patient name, date of birth, address, contact number, and dates of the records to be released; indicate the purpose (e.g., continuation of medical care or insurance purposes); specify which records to disclose; sign and date. A photocopy is valid.

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

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