Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Mayo Clinic Health System Wisconsin (MCHS WI). Before sending anything sensitive, confirm the number and receiving department directly with Mayo Clinic Health System Wisconsin (MCHS WI), and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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Mayo Clinic Health System Wisconsin (MCHS WI) fax number
(715) 838-3058
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Health Information Management Services (ROI)
Used for: Authorization to Release Protected Health Information to a Third Party; release of medical records to third parties
Fax destination details
- Department
- Health Information Management Services (ROI)
- Purpose
- Authorization to Release Protected Health Information to a Third Party; release of medical records to third parties
- Form
- Authorization to Release Protected Health Information to a Third Party — Authorization to Release Protected Health Information to a Third Party
- Address
- 1400 Bellinger Street, Eau Claire, WI 54703-5211
- Voice phone
- 715-838-6395
- 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.
Fill patient name, birth date, and contact details; select Mayo Clinic or other recipient; specify which records to release; sign and date; submit to Health Information Management Services (ROI) for processing.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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