Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Providence Health & Services (Oregon Region) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Providence Health & Services (Oregon Region) fax number

(503) 215-0405

Release of Information (ROI) Central Reception / Health Information Management

Used for: Medical records release / PHI disclosure requests

Fax destination details

Department
Release of Information (ROI) Central Reception / Health Information Management
Purpose
Medical records release / PHI disclosure requests
Form
Authorization to Use, Disclose & Release Protected Health Information — AUTHORIZATION TO USE, DISCLOSE & RELEASE PROTECTED HEALTH INFORMATION
Address
P.O. Box 4950, Portland, OR 97208
Voice phone
503-215-7425

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.
  • Keep the delivery confirmation with your submission records.

Form explains authorization to disclose health information, what records may be released, purpose, any limitations, optional directions (fax, email, etc.), and expiration (typically 180 days). Signature required. Certain information may be restricted by state/federal law.

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

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