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Nephrology Associates of Tidewater, Ltd. fax number
(757) 466-8123
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Nephrology Associates of Tidewater, Ltd. – Release of Protected Health Information (locations include Kempsville, Medical Tower Norfolk, Chesapeake, Suffolk/Franklin, Eastern Shore, and Virginia Beach)
Used for: Authorization for release of protected health information (medical records) via fax
Fax destination details
- Department
- Nephrology Associates of Tidewater, Ltd. – Release of Protected Health Information (locations include Kempsville, Medical Tower Norfolk, Chesapeake, Suffolk/Franklin, Eastern Shore, and Virginia Beach)
- Purpose
- Authorization for release of protected health information (medical records) via fax
- Form
- Authorization to Release Protected Health Information — Authorization to Release Protected Health Information
- Address
- 6160 Kempsville Circle, Suite 302A, Norfolk, VA 23502; 400 Gresham Drive, Suite 907, Norfolk, VA 23507; 300 Medical Parkway, Suite 222, Chesapeake, VA 23320; 2790 Godwin Boulevard, Suite 255, Suffolk, VA 23434; P.O. Box 923, 9550 Hospital Avenue, Nassawadox, VA 23413; 1800 Camelot Drive, Suite 401, Virginia Beach, VA 23454
- Voice phone
- 757-466-9288
- Website
- Visit organization website
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Sign and date to authorize release of specified medical information (clinic notes, lab reports, radiology, etc.) to a recipient; specify service dates if needed; one-year expiration unless otherwise noted; certain sensitive information may require explicit authorization.
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