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Piedmont HealthCare fax number

(704) 696-2570

Medical Records

Used for: Submitting Medical Records Release Form / authorization for the use and disclosure of protected health information (PHI).

Fax destination details

Department
Medical Records
Purpose
Submitting Medical Records Release Form / authorization for the use and disclosure of protected health information (PHI).
Form
Medical Records Release Form — Authorization for the Use and Disclosure of Protected Health Information
Address
P.O. Box 1845, Statesville, NC 28687
Voice phone
704-978-3546

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 the Medical Records Release Form with patient identifying information and the scope of records to be disclosed, then fax to 704-696-2570.

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

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