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Pediatric Partners of Augusta, LLC fax number

(706) 854-2534

Used for: Medical records transfer/release requests

Fax destination details

Purpose
Medical records transfer/release requests
Form
Authorization to Transfer and Release Medical Records — Authorization to Transfer and Release Medical Records
Address
1303 D’Antignac St, Suite 2600, Augusta, GA 30901
Voice phone
706-854-2500

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.

The form requires patient name(s), date(s) of birth, physician/provider, signature of the responsible party, relationship to patient, and today's date; it authorizes release of medical records and notes a $30 per-record copying fee.

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

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