Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Mesilla Valley Hospital before sending sensitive documents. FaxFlow is not affiliated with this organization.
Mesilla Valley Hospital fax number
(575) 382-4904
Medical Records Department
Used for: Medical records release / disclosure authorization (Authorization for Disclosure, Use or Receipt of Protected Health Information)
Fax destination details
- Department
- Medical Records Department
- Purpose
- Medical records release / disclosure authorization (Authorization for Disclosure, Use or Receipt of Protected Health Information)
- Form
- ROI Form 1504 — Authorization for Disclosure, Use or Receipt of Protected Health Information
- Address
- 3751 Del Rey Blvd, Las Cruces, NM 88012
- Voice phone
- (575) 382-3500
- 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 in all fields, sign and date the form, and include your phone number. Provide patient or authorized representative details, designate the recipient (e.g., Medical Records), and fax the completed form to 575-382-4904 or mail to Mesilla Valley Hospital, 3751 Del Rey Blvd, Las Cruces, NM 88012. The form expires 180 days after signing.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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