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 It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Michiana Behavioral Health. Before sending anything sensitive, confirm the number and receiving department directly with Michiana Behavioral Health, 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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Michiana Behavioral Health fax number
(574) 941-5703
Wrong or outdated? Report this number
Behavioral Health
Used for: PHI release form submission / medical records request
Fax destination details
- Department
- Behavioral Health
- Purpose
- PHI release form submission / medical records request
- Form
- Authorization for Release of Protected Health Information — Authorization for Release of Protected Health Information
- Address
- 1800 N Oak Dr, Plymouth, IN 46563
- Voice phone
- 574-936-3784
- 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.
Complete patient name, birth date, any previous names, dates of service; indicate whether records are released to Self or an Agency/Organization and provide recipient's name, telephone, and mailing address; sign and date; submit according to the form's directions.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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