Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Mayo Clinic Health System Wisconsin (MCHS WI) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Mayo Clinic Health System Wisconsin (MCHS WI) fax number

(715) 838-3058

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

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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