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MaineHealth fax number
(207) 761-3092
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Health Information Management Department
Used for: Requests for medical records (PHI) and releases; submitting an Authorization to Release Protected Health Information to have records released to another provider or to the requester.
Fax destination details
- Department
- Health Information Management Department
- Purpose
- Requests for medical records (PHI) and releases; submitting an Authorization to Release Protected Health Information to have records released to another provider or to the requester.
- Form
- 144028 — Authorization to Release Protected Health Information (PHI)
- Address
- Health Information Management Department, 301C US Route One, Scarborough, ME 04074
- Voice phone
- 207-662-2211
- 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.
Download and complete the Authorization to Release Protected Health Information form, sign and date, include a legible photo ID, and submit via MyChart, email, mail, or fax to 207-761-3092. If mailing or faxing, address to Health Information Management Department, 301C US Route One, Scarborough, ME 04074; Fax: 207-761-3092.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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