Optum Health Information Management fax number

Fax destination details

Department

Medical Records / Health Information Management

Purpose

Medical records request / release of protected health information (PHI) to a designated recipient

Form

HIPAA Authorization Form — HIPAA authorization form – Nevada (Optum Health Information Management)

Address

Optum Health Information Management, P.O. Box 15645, Las Vegas, NV 89114-5645

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 this form to authorize the release of your PHI to the designated recipient. Include patient information, PHI description, and the recipient's details; sign and date. Return via fax to Optum Health Information Management.

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