Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Old Vineyard Behavioral Health Services before sending sensitive documents. FaxFlow is not affiliated with this organization.
Old Vineyard Behavioral Health Services fax number
(336) 794-4351
Release of Information
Used for: Authorization for Release of Confidential Information / request for medical records
Fax destination details
- Department
- Release of Information
- Purpose
- Authorization for Release of Confidential Information / request for medical records
- Form
- Authorization for Release of Confidential Information — Authorization for Release of Confidential Information
- Address
- 3637 Old Vineyard Road, Winston-Salem, NC 27104
- Voice phone
- 336-794-4391
- 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 out patient and recipient details, specify the records to disclose and the dates, sign; some information may be sensitive and is released in accordance with confidentiality rules.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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