Nephrology Associates of Tidewater, Ltd. fax number

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

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.

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.

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