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MidAmerica Cancer Care fax number

(816) 683-7645

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Research

Used for: New patient referral submission

Fax destination details

Department
Research
Purpose
New patient referral submission
Form
New Patient Referral Form — New Patient Referral Form
Address
2316 E Meyer Blvd, 1 East, Kansas City, MO 64132
Voice phone
(816) 974-5050

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 required fields: Reason for consult/DX code (required); Urgency (ASAP, Routine, etc); Patient name, address, date of birth, phone; Referring doctor, primary physician, contact info; Primary insurance and policy details; Attach recent office notes, labs, radiology reports, and pathology; Indicate location (Research, Belton, or Providence) and preferred provider; Fax referral to 816-683-7645 or call 816-974-5050 for processing.

Official form instructions are published as a downloadable file on the organization's website.

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