Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Long Beach Memorial Medical Center (MemorialCare Health System) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Long Beach Memorial Medical Center (MemorialCare Health System) fax number

(562) 933-1185

Medical Records Department

Used for: Medical records release / authorization to disclose protected health information (PHI)

Fax destination details

Department
Medical Records Department
Purpose
Medical records release / authorization to disclose protected health information (PHI)
Form
Authorization to Use and Disclose Protected Health Information — Authorization to Use and Disclose Protected Health Information
Address
Long Beach Memorial Medical Center / Miller Children’s Hospital Long Beach / Community Hospital Long Beach, 2801 Atlantic Avenue, Long Beach, CA 90806
Voice phone
(562) 933-2000

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 the attached form to request your medical records: provide demographic information, specify the provider/records to disclose (e.g., complete medical record, history & physical, etc.), indicate how you want records delivered, sign and date, and provide a valid photo ID. The authorization is typically valid for 90 days; fees may apply for copies; submit in person, by fax, or by mail to the Medical Records Department.

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

Sources and verification

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