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Palo Verde Pain Specialists fax number

(602) 714-7176

Used for: Medical records requests and disclosures; release of health information and related authorization forms; appointment communications

Fax destination details

Purpose
Medical records requests and disclosures; release of health information and related authorization forms; appointment communications
Form
Authorization to Disclose Health Information (Medical Record Release) — Authorization to Disclose Health Information to Palo Verde Pain Specialists
Address
13090 N 94th Dr Ste 212, Peoria, AZ 85381; 2905 W Warner Rd Ste 19, Chandler, AZ 85224
Voice phone
(833) 578-7246

Before you send

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  • 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.
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Complete patient data, sign, and specify the purpose for disclosure; include date of birth and patient relationship if required.

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